Abstracts

Levetiracetam (LEV) is a well-tolerated antiepileptic drug used worldwide as an adjunctive treatment in adult patients with partial-onset seizures. Its efficacy and tolerability were demonstrated in some pivotal clinical studies ( 1-2), and can be safely initiated at 2,000 mg daily without a titration period (3), but little data exist regarding its use in status epilepticus(SE)., We describe a case of refractory SE requiring 9 days of pharmacological coma with subsequent excellent neurological recovery after adjunctive nasogastric LEV.
On December 29^th, 2005, a 25-years old man with SE presented to hour hospital. He had endotracheal intubation and admitted to the emergency unit. SE showed partial crisis as clonic and mioclonic crisis and tonic-clonic crisis. The patient had a post-surgery panhypopituitarism for craniopharyngioma and he had never had any convulsions. The treatment protocol started with midazolam 0.2 mg/kg/hour/die e.v. and phenobarbital (PB) 100 mg i.m. SE didn[apos]t stop and the day after PB was increased at 200 mg daily. On January 3th, midazolam was substituted with propofol 1 mg/ml i.v., PB was reduced at 100 mg/daily and sodium valproate (sVLP) 25 mg/Kg/daily i.v. was added but without success, so on January 5^th, 2006, PB was stopped and nasogastric LEV 1000 mg three times daily, without titration, was added., The patient showed a dramatic recovery when nasogastric LEV was added and while EEG performed on day 4^th, showed polyspike-wave complex on left temporo-central-occipital derivations combined with slow activity and burst-suppressions of short duration (Fig.1a), EEG performed on day 11th, showed low amplitude polyspikes on left fronto-central derivations (Fig. 1b) and EEG updated on day 40^th, showed no epileptiform activity (Fig. 1c).
CT scan performed on day 10th (Fig. 1d), and MRI performed on January 3th, 2006 (Fig. 1f) and on January 27th, 2006 (Fig. 1g), showed no differences compared by an MRI performed on june 2005 (Fig. 1e)., For our knowledge this is the first case of 3000 mg daily, without titration, nasogastric LEV treatment of refractory SE resistant at midazolam iv plus PB im and sVLP iv, at propofol iv plus sVLP. In fact only the LEV 3,000 mg daily added via nasogastric stopped dramatically status epilepticus. No significant adverse events were noted. In this case-report we showed that levetiracetam as add-on, had a rapid protection against clonic and mioclonic seizures. We conclude that adjunctive LEV should be considered for patients with status epilepticus unresponsive to initial therapy.[figure1],