Abstracts

Rationale: Levetiracetam (LEV) has been used as an effective broad-spectrum antiepileptic drug (AED) for almost 10 years. Recently, an intravenous (IV) formulation was introduced and has been utilized in the acute hospital setting in patients with seizures. Although its efficacy against status epilepticus has not been established, it has been used widely in this setting due to favorable safety profile and lack of drug-drug interactions. We have reviewed the utilization of IV LEV in order to evaluate safety and tolerability. In addition, we have reviewed the indicated neurological conditions in which it was used, and the retention rate of this medication at discharge from acute hospitalization. Methods: We have retrospectively reviewed the utilization of IV LEV in the acute and critical care settings from August 2006 to March of 2007 at the Barrow Neurological Institute. Information was collected regarding underlying neurological conditions, purpose of LEV use, efficacy, dosage, adverse effects, EEG findings, and retention rate. Results: There were 122 cases with a mean age of 56 years (ranged from 3 months to 96 years). Ninety-six percent of these patients received LEV for the first time. These patients had variety of different diagnoses led by brain tumor (16%), intraparenchymal hemorrhage (11%), status epilepticus (11%), subdural hematomas (9%), trauma (4%), infection (4%), and ischemic stroke (4%). Most commonly, IV LEV was given as a second-line agent, and in less than 10%, it was given as a first line agent. The initial IV LEV dosage was ranged from 500 mg to 1500 mg over 15 minutes regardless of dosage. The common EEG findings were epileptiform discharges (41%), diffuse slowing (22%), or focal slowing (11%). There was no significant complications reported associated with LEV infusion. Specifically, there was no cardiac arrhythmia, hypotension, or metabolic derangement, which are reportedly common with other IV AEDs. Due to underlying cognitive impairments of these patients, CNS side effects were difficult to assess but worsening of sedation was not reported. At point of discharge, 54% of the patients were continued on oral LEV (66% as monotherapy). The patient’s overall neurological outcome was related mainly to the underlying CNS pathology and the use of IV LEV did not appear to be associated with any particular outcome. At discharge, 52% of patients were sent to rehab or skilled nursing facility, 22% were sent home, and 26% were sent to hospice or died. Conclusions: IV levetiracetam can be used safely used in acute seizure treatment or prevention of seizure in patients with multiple different CNS pathologies. Cardiac and metabolic side effects appear to be rare with infusion of IV levetiracetam. More than half of patients continued to take levetiracetam at the time of discharge