Abstracts

Mesial Temporal Sclerosis (MTS) is the most common cause of refractory temporal lobe epilepsy. It is also the one most often treated surgically, because medical treatment fails in upto75% of cases, and surgical treatment is successful in about 58%[sup1].
This study was undertaken to determine the efficacy of Levetiracetam in the treatment of Temporal Lobe Epilepsy in patients with Mesial Temporal Sclerosis., This is a retrospective study looking at our database of over 1000 epilepsy patients. The patients were classified as having Temporal Lobe Epilepsy and Mesial Temporal Sclerosis based on the following criteria:
A. Video-EEG confirmation of Temporal Lobe Epilepsy by ictal and interictal recordings and no other contradictory data and MRI showing mesial temporal sclerosis.
Or
B. Electroencephalogram showing epileptiform discharges consistent with Temporal Lobe Epilepsy, clinical features consistent with Temporal Lobe Epilepsy and MRI showing mesial temporal sclerosis. No contradictory data.
Thirty patients fulfilled the above criteria and were started on Levetiracetam. The patients were followed for an average of 20 months from the time of starting Levetiracetam. No other antiepileptic drug changes were made during this period in these patients. One patient could not afford the medication after being started on Levetiracetam and three patients had no follow up after Levetiracetam was started. Therefore, the total number of patients were 26.
The outcome was classified as:
[underline]Class 1:[/underline] Seizure free
[underline]Class 2:[/underline] [gt] 50% reduction in seizure frequency
[underline]Class 3:[/underline] [lt] 50% reduction in seizure frequency
Patients in Class 1 and 2 were designated as responders., Twenty-one of the 26 patients (80.7%) with Temporal Lobe Epilepsy and MTS had a greater than 50% reduction in seizures. Ten of the 26 (38.4%) patients became seizure free. The average number of antiepileptic drugs these patients had failed is 3.13 before starting Levetiracetam.
[underline]Class 1: 10 patients (38.5%)
Class 2: 11 patients (42.3%)
Class 3:[/underline] 5 patients (19.2%)
38.5% of patients with Temporal Lobe Epilepsy and MTS, who had failed an average of more than 3 antiepileptic medications, became seizure free on treatment with Levetiracetam. The responder rate was 80.7%.
The responder rate for Levetiracetam in all partial seizure is 39.8% to 44%[sup2]., This study clearly demonstrates a unique efficacy profile of Levetiracetam in Temporal Lobe Epilepsy with MTS. Large randomized controlled studies are needed to study this important efficacy profile.

1. Spencer SS. When should temporal-lobe epilepsy be treated surgically? Lancet Neurol; 2002; 1(6):375-82.
2. Cereghino JJ, Biton V, Abou-Khalil B, Dreifuss F, Gauer LJ and Leppik I. Levetiracetam for partial seizures: results of a double-blind randomized clinical trial. [italic]Neurology[/italic] 2000; 55(2):236-242.,