Abstracts

We have previously demonstrated the efficacy of Levetiracetam (LEV) as monotherapy for patients with epilepsy at 6 months. We sought to evaluate our 1-year experience with LEV as monotherapy and compare it with our 6 months experience.
We retrospectively reviewed the charts of all of our patients with a confirmed diagnosis of epilepsy who tried LEV monotherapy. Patients began LEV either as first line therapy or were converted to LEV monotherapy after failing their prior antiepileptic medications (AEDs).
We reviewed demographic data, diagnostic evaluation for epilepsy, seizure types, and seizure frequency prior to and following initiation of LEV monotherapy. Adverse events (AE) while on LEV were noted.
We identified 41 patients, ages 18-91, (mean 41.1) with history of partial seizures with and without secondarily generalization. The duration of epilepsy ranged from 1-30 years, (mean 14 years). Three patients withdrew secondary to AEs. Six patients had no significant change at 6 months follow-up, of which only 1 patient elected to continue on LEV. Three patients lost to follow up after 6 months visit. This leaves 30 patients for analysis. Six of these patients began LEV as first line therapy, three of which had liver disease. Twenty-four patients were converted to LEV monotherapy after they failed their initial trials of AEDs, which included Dilantin, Tegretol, Depakote, Lamictal, and Topamax, (mean 2.11).
At 1 year follow up: Sixteen of the 30 (53%) were seizure free. Five patients who began LEV monotherapy were seizure free, whereas the remaining 11 patients who began LEV as add-on therapy became seizure free. Of the remaining patients 7/30 (23%) had more than 50 % seizure reduction and 4/30 (13%) patients had [gt] 75% reduction of seizures. One patient had no significant change in seizure frequency. The remaining 2 patients had more than 25% but less than 50% reduction in seizure frequency. The total dosages used to control seizures were 1000-4000 mg/day (mean 2454 mg/day).
For the 16 seizure free patients at 6 months, 15 patients (94%) remained seizure free at 12 months; whereas, for the 14 non-seizure free patients at 6 months: 5/14 (36%) patients had worse seizures at 12 months and 8 patients (57%) had the same seizure control. Two patients (14%) had better seizure control at 1-year follow-up compared to 6 months.
LEV monotherapy can be effective and well tolerated in adults with new onset and difficult to control epilepsy. Most patients were able to sustain this efficacy at 1-year follow-up compared to six months. A prospective, large, double-blind study is needed to confirm this finding.