Abstracts

Rationale: To evaluate the efficacy and safety of levetiracetam in children younger than 4 years with refractory epilepsy. Methods: Thirty four children younger than 4 years diagnosed as having refractory epilepsy were enrolled in Seoul National University Children’s Hospital. Their clinical data were analyzed retrospectively. Results: The mean age at the time of initial levetiracetam treatment was 2.3 years (4 months - 4 years) and mean duration of treatment was 8.7 months (4 days -13 months). Mean number of antiepileptic medication was 2.9 at the starting point of levetiracetam medication. More than a 50% reduction in seizure frequency was noted in 11 patients (11/34; 32.4%) with 4 patients achieving seizure freedom. Specifically, more than a 50% seizure control was attained in 5 patients (5/9; 56%) with focal cryptogenic epilepsy, 4 patients (4/11; 36%) with focal symptomatic epilepsy, 1 patients (1/2; 50%) with generalized epilepsies, 1 patient (1/6; 17%) with Lennox-Gastaut syndrome. The mean daily dosage of levetiracetam was 52 mg/kg (range, 21 to 123 mg/kg/day). Mean dose of levetiracetam in patients with at least 50% of seizure reduction was 42mg/kg/day, while mean dose in poor responder was 58 mg/kg/day. Doses of levetiracetam in 4 patients achieving seizure freedom were 21mg/kg, 21mg/kg, 38mg/kg, and 50mg/kg respectively. Ten patients were treated with doses higher than 60mg/kg/day, however, only one patient had more than 50% seizure reduction. Three patients were treated with up to 100mg/kg/day without seizure reduction but none of them were reported to have recognizable side effects. Levetiracetam was discontinued in 8 patients (24%) due to poor efficacy in 4 (12%), side effects in 2 patients (6%), and both of poor efficacy and side effects in 2 (6%). Side effects included lethargy in 3 patients, irritability in 2 and cognitive disturbance in one patient. Conclusions: We could get good response to levetiracetam treatment in more than 30% of pediatric patients with refractory epilepsy without significant side effect. Levetiracetam seemed to be effective in children with refractory epilepsy and well tolerated at doses exceeding 60mg/kg/day.