Abstracts

Rationale: Genetic generalized epilepsies (GGEs) are a group of epilepsy syndromes that are believed to have a strong underlying genetic basis with no clear structural or anatomic cause. Some of the GGEs can continue lifelong and may be refractory to certain medications. Thus, this creates the need for therapeutic strategies when treating patients with refractory generalized epilepsies. Several investigators have reported that sodium valproate acid reduces inter-ictal discharges in patients with GGEs, but there is a lack of information on the effect of levetiracetam on inter-ictal discharges in generalized epilepsies. Although levetiracetam has shown anti-seizure effect for both focal and generalized epilepsies, the effect on inter-ictal activity is not well reported (Rocamora R, Wagner K, Shculze-Bonhage A. Levetiracetam reduces frequency and duration of epileptic activity in patients with refractory primary generalized epilepsy. Science 2006; 15: 428-433). Methods: A case report. Results: This is a 16-year-old female who presented to the epilepsy monitoring unit (EMU) for characterization of her spells. The patient started having seizures at the age of two which were reported to be generalized tonic-clonic convulsions. She later developed other spells in which she was staring ahead and unresponsive with associated stiffening. A few months prior to her admission to the EMU, the patient started having spells in which she would have whole body shaking, hyperextension of the neck, and a sensation of not being able to breathe. She did not have any risk factors for epilepsy but did have a positive family history of epilepsy from her maternal aunt. The patient was initially started on levetiracetam. Oxcarbazepine was added to her medication regimen after the most recent spells started. These medications were weaned off while she was in the EMU with oxcarbazepine being weaned off initially. During the first three days of recording, there was no inter-ictal activity. In fact, three non-epileptic spells were recorded during this time frame. However, two days after being off of levetiracetam, frequent generalized 3-4 Hertz spike and wave discharges were seen, at times, in runs lasting 2 to 3 seconds. The number of these generalized discharges decreased significantly after restarting levetiracetam and there was no inter-ictal activity during the last 14 hours of her recording. Thus, we concluded that the patient had a well-controlled GGE in addition to the presence of psychogenic non-epileptic seizures (PNES). Conclusions: The patient presented with genetic generalized epilepsy and no inter-ictal epileptiform discharges while on levetiracetam. Most of the investigations in the past have revealed that sodium valproate reduces inter-ictal discharges in GGEs, however there is very little data on the effect of levetiracetam on inter-ictal discharges on GGE. We propose that levetiracetam suppresses generalized inter-ictal discharges as described in this case. Furthermore, the findings of well controlled GGE in the presence of PNES may have been missed had a decision been made to discharge the patient immediately after recording the PNES spells. This suggests that longer EMU admissions may be of benefit from a diagnostic standpoint. Funding: Not applicable