Abstracts

RATIONALE: Levetiracetam received US FDA approval in 1999 for adjunctive therapy for partial onset seizures in adults. There have been reports concerning the efficacy of levetiracetam in children with epilepsy. However, there is a paucity of data concerning the use of levetiracetam as a monotherapeutic agent in pediatric patients.
METHODS: Medical records of 51 patients receiving levetiracetam were retrospectively reviewed in order to identify patients who were seizure free on levetiracetam prescribed as initial, or conversion to, monotherapy.
RESULTS: Six pediatric patients, (8-19 years, 2 males, 4 females), were seizure-free on levetiracetam monotherapy. Age of seizure onset ranged from 2.5-18 years. Five patients had complex partial seizures, and one experienced two convulsions of unclear seizure type; this patient had a family history of epilepsy, while the other patients did not. All children had normal clinical neurological examinations; only one had a previous diagnosis of Neurodevelopmental Delay. One patient had mesial temporal sclerosis on MRI; the other five patients had normal MRIs. EEGs were variable, ranging from frontal spikes in one patient, focal spikes in two (left temporal and left central spikes) and three patients with normal EEGs. Two patients were seizure free after beginning levetiracetam as initial monotherapy. Four patients had failed 1-3 anti-epileptic drugs (AEDs) prior to levetiracetam as add-on therapy; these patients were successfully converted to levetiracetam monotherapy. Effective doses of levetiracetam ranged from 750 mg/day to 2250 mg/day, given in two divided doses. Patients were seizure free from 6-22 months. None of the patients reported any adverse effects.
CONCLUSIONS: Two children became seizure free with levetiracetam initial monotherapy. Four children became seizure free with levetiracetam add-on therapy with successful conversion to monotherapy. Levetiracetam was well tolerated. Levetiracetam may be a beneficial and well tolerated monotherapeutic AED in selected pediatric patients. Further research is necessary to define the efficacy and sustainability of levetiracetam as a monotherapeutic AED for pediatric epilepsy.
[Supported by: UCB Pharma]; (Disclosure: Grant - Participate as a site for UCB Pharma clinical trials of levetiracetam in children: Study N159 and N157, Consulting - UCB Pharma, Honoraria - UCB Pharma)