Abstracts

RATIONALE: Levetiracetam is a novel antiepileptic drug with proven efficacy against partial seizures. Controlled studies of patients with generalized seizures have not yet been conducted, subgroup analyses from multicenter studies demonstrate that levetiracetam reduces seizure frequency in patients with refractory secondarily generalized seizures. There is limited information about its effectiveness against primarily generalized seizures. In animal models levetiracetam protects against seizures in audiogenic susceptible rodents, and it is effective in the Genetic Absence Epilepsy Rat from Strasbourg model of absence seizures. We report the results of an open study on the efficacy of levetiracetam as monotherapy in six patients with idiopathic generalized epilepsies.
METHODS: Median age at treatment onset was 19.5 years (14-37). All 6 patients demonstrated at baseline generalized spike-waves discharges and photo-paroxysmal responses in three. Three patients were diagnosed as juvenile myoclonic epilepsy (JME), one eyelid myoclonia with absences (EMA), one juvenile absence epilepsy (JAE), one pure photosensitive epilepsy (PPE). Two patients were treated with levetiracetam as first monotherapy. Four were treated with levetiracetam monotherapy after a failure or unacceptable side effect of sodium valproate. Levetiractam efficacy was evaluated clinically and by EEG-video monitoring
RESULTS: Median follow up was 6.5 months (6-8). Median dosage of levetiracetam was 2 grammes (0.5-2). All patients with JME showed a complete seizure control either for myoclonic jerks and generalized tonic-clonic seizures. Patient with EMA and JAE had an incomplete seizure control. Patient with pure photosensitive epilepsy was seizure free. During the follow up period awake and sleep EEG normalized in 4, photo-paroxysmal responses was reduced in three patients.
CONCLUSIONS: This study suggest that levetiracetam monotherapy could be effective in idiopathic generalized epilepsies (myoclonic, generalized tonic-clonic seizures). Prospective randomized clinical studies are required. Currently, a multicenter controlled clinical trial of levetiracetam for tonic-clonic and myoclonic seizures is being conducted in patients with juvenile myoclonic epilepsy.