Abstracts

Adjuntive treatment with Levetiracetam (LEV) may be efficacious in intractable epilepsy, however, in the developmentally delayed population with Lennox Gastaut syndrome (LGS) there is concern regarding cognitive side effects as well as the effects of polypharmacy. This may lead to early termination of the drug and lack of benefit. This study aims to demonstrate the effects of LEV on patients with LGS on multiple antiepileptic drugs. Treatment with LEV in patients with LGS was examined in a retrospective chart review from an epilepsy clinic. Sixty-nine patients with LGS had been identified and 19 were treated with Levetiracetam as an adjunct during their evaluation and treatment over the past 4 years. Diagnosis of LGS was confirmed by demonstrating multiple seizure types and documenting EEG findings of slow spike wave with mental retardation (MR). The number of AEDs used, current and past, and the use of Vagus Nerve Stimulation (VNS) was also followed. The percent reduction in seizures and duration of therapy was calculated after the introduction of LEV. The reason for termination of LEV in patients that did not benefit from adjunctive therapy was determined to be either due to continued intractability or intolerance of side effects. Moderate to severe MR occurred in 10 males and 9 females with average age of 34.5 years. An average of 2.5 other concurrent AEDs were being used prior to initiation of LEV. An average of 5 other AEDs had be tried prior to the current regimens. Six of the 19 patients were also treated with VNS and continued to have intractable epilepsy. Average duration of treatment was 21 months. Seven patients had a reduction in seizure frequency (3 with 65-75% reduction, 3 with a 50-60% reduction and 1 with a 25% reduction). Eleven had no change in seizure frequency and one had a 60% increase in seizure rate. Side effects of lethargy and irritability were noted on the multiple drug regimens, however, all discontinuations of LEV were due to continued intractability and not due to intolerance. This retrospective analysis suggests treatment of intractable epilepsy in LGS with LEV is effective when used as an adjunct with other medications. Overall, 37% of patients had a response of reduced seizures. Efficacy and tolerability was maintained despite a 21 month average length of treatment. (Supported by UCB-Pharma)