Abstracts

Rationale: Levetiracetam is a broad-spectrum anti-epileptic drug with proven efficacy in both partial and generalized seizures. Besides having a favorable safety and tolerability profile, it has no drug-drug interaction. It has been widely available in tablet form since 1999 and in oral solution since 2003; however, its intravenous formulation was only recently approved by the FDA in July 2006. Although there is some literature on the safety and pharmacokinetics of intravenous levetiracetam, there is little data on its use and application in pediatric epilepsy. Methods: To assess its use in the pediatric population, a retrospective chart review was performed at Rainbow Babies and Children’s Hospital. Recorded parameters included sex, age, seizure etiology, seizure type, indication for treatment, dosage and duration of treatment, efficacy and any side effects.Results: Between October 2006 and April 2007, 38 patients were treated with intravenous levetiracetam at Rainbow Babies and Children’s Hospital. 34 of 38 charts (90%) were available for review. Of the 34 patients, 19 were male (56%) and 15 were female (44%). The mean age was 8.8 years (8 months-18 years). 21 of 34 patients had partial seizures. Generalized seizures occurred in 12 patients including absence (n=2), myoclonic (n=2), and generalized tonic-clonic seizures (n=8). One patient with a brain tumor had no previous seizures but was considered at high risk. Seizure etiologies varied from metabolic and genetic diseases (n=7), tumor (n=4), cortical dysplasia (n=2), stroke (n=1), and unknown (n=20). Three patients had new onset seizures that were frequent. Fifteen patients had breakthrough seizures on their existing anti-epileptic regimen (1-3 drugs) with 3 patients in partial status epilepticus. Fifteen patients were switched from oral to the intravenous formulation because of oral intake restriction for surgery, recurrent emesis etc. In one patient, the intravenous formulation was used for seizure prophylaxis. The treatment duration was 1 to 7 days. The loading dose varied from 15-30 mg/kg. The maintenance dose ranged from 15-50 mg/kg/day. During the hospitalization, seizure control was achieved in 2 of 3 patients with new onset seizures and 10 of 12 patients with poorly controlled seizures on other anti-epileptic regimens. Seizures were not controlled in 3 patients with partial status epilepticus and required other interventions. The remaining patients, including those converted from oral to intravenous therapy, had no seizures. Intravenous levetiracetam was well tolerated. No new adverse effects were reported, although there were prior complaints of irritability and fatigue in two patients. Conclusions: The intravenous formulation of levetiracetam was efficacious and well tolerated in majority of our patients. It is a good option for pediatric patients who need rapid titration of anti-seizure therapy because of frequent seizures or oral intake restriction. Its inefficacy in 3 patients with partial status epilepticus may, in part, be due to suboptimal dosing.