Abstracts

During the past 3 years, levetiracetam (LEV) was used as a first line treatment for all patients diagnosed with juvenile myoclonic epilepsy (JME) and juvenile absence epilepsy (JAE) at the Neurology Clinic of the Children[apos]s Hospital at Vanderbilt. Valproate, the usual first line agent for JME, poses risk of chronic side effects that include weight gain, increased risk of birth defects in pregnant women, liver failure, aplastic anemia, and polycystic ovary syndrome. Since the diagnosis of JME usually requires lifetime treatment, patients could benefit from drug therapy with less adverse reactions. We performed a retrospective review on the medical records patients with potential JME seen at Vanderbilt Children[apos]s Hospital. Search words of JME, juvenile myoclonic epilepsy, and levetiracetam (Keppra) searched an electronic record file to identify 43 potential patients for study. Broad inclusion criteria were set, which included age of onset between 5 and 21 years, treatment with LEV, and diagnosis of certain or probable JME.
The electronic medical records review included a search for the inclusion criteria, the current patient age; all AED use (both inappropriate and appropriate AEDs); AED efficacy; and AED adverse effects. We reviewed and documented the onset of LEV use, the starting and final doses used, and duration of LEV therapy. Thirty of the 43 patients met the criteria outlined. In these 30 consecutive patients, 24 (80%) patients became seizure free with levetiracetam monotherapy and two additional patients showed improved seizure control. Effective treatment doses ranged from 12 mg/kg/d to 50 mg/kg/d. The average length of follow up on patients achieving seizure freedom was 27 months. Previous exposure and treatment failure with valproate did not significantly affect the likelihood for complete seizure control; 7 of 9 patients became seizure free on LEV after failing trials of valproate. Patients fitting juvenile myoclonic epilepsy criteria closely showed the best response within the study group (11 of 11 seizure-free). Patients never previously treated with other appropriate AEDs showed a higher response rate (14 of 16 were seizure free). Risk factors for lesser response included the presence of absence seizures (12 of 18 seizure free), male gender and not fulfilling strict criteria for JME (1 of 5 seizure free). Photoparoxysmal response, slight learning disabilities, and unclear history of myoclonic jerks (that would make them less likely to fulfill JME criteria) did not adversely affect responsiveness. Only one patient stopped LEV due to adverse mood alterations after one year of treatment. The study supports using levetiracetam as first line agent in the treatment of JME. However, the findings need to be confirmed with prospective investigations with larger number of patients with juvenile myoclonic epilepsy and juvenile absence epilepsy.