Abstracts

Rationale: We describe the efficacy and tolerability of intravenous levetiracetam (IV-LEV) as treatment of non convulsive status epilepticus in elderly patients. Methods: We administered intravenous levetiracetam in three consecutive elderly patients referred to our epilepsy center because of non convulsive status epilepticus consisting in impairment of consciousness, bizarre behaviours, psychomotor slowdown and ataxia. Each patient has performed a standard EEG when he arrived at the hospital and during the entire time of infusion of IV-LEV. All patients have performed an EEG 3 and 24 hours after LEV administration. In 2 patients the dosage of IV-LEV was 1000 mg diluted in 100 cc of physiological solution administered in 15 minutes, in 1 patient we administered 1500 mg of IV-LEV diluted in 50 cc of physiological solution in 5 minutes. All 3 patients have been taking chronic antiepileptic treatment at the moment of non convulsive status epilepticus onset. Results: Both first and second patient showed an EEG improvement about 10 minutes after LEV infusion and a complete disappearance of both continuous epileptic activity and clinical picture at the end of infusion. 1 adsverse event (marked somnolence) occurred in both patients. During the EEG evaluation, 3 hours after infusion, both patients showed reappearance of continuous lateralized epileptiform discharges and we administered IV-LEV at the same dosage but increasing speed of infusion (10 minutes): epileptic activity disappeared after 5 minutes. EEG after 3 and 24 were normal. The third patient was treated with1500 mg of IV-LEV diluted in 50 cc of physiological solution, time of infusion 5 minutes;the EEG performed during infusion showed disappearance of both epileptic discharges and clinical picture (2 minutes after starting infusion). We performed also an ECG monitoring that showed no abnormalities.Adverse event (marked somnolence) occurred. The EEG evaluations performed 3 and 24 hours after infusion were both normal. Conclusions: Efficacy and tolerability of IV-LEV in elderly patients with non convulsive status epilepticus seemed to be good in our three subjects. While the tolerability was similar with different dosage and different speed of infusion, the efficacy seemed linked to dosage and speed of infusion of IV-LEV but we should need further studies and wide sample to confirm this empiric postulate.