Abstracts

Levetiracetam, although currently approved only as adjunctive therapy in the treatment of epilepsy, may be efficacious as a monotherapy across a broad range of seizure disorders., We retrospectively identified eighty-five patients (ages 8 months-98 years; mean 39 years; 51 male, 34 female) with various seizure disorders having been treated with levetiracetam (LEV) monotherapy. While the criteria for inclusion consisted of any length of mono- treatment (mean 7.2 months), changes in seizure frequency and seizure freedom were evaluated in three month intervals up to one year. Patients began LEV as either first line therapy (n=38) or were converted to LEV from other AEDs (n=47). Medical records were reviewed for seizure type (primary generalized vs. partial), etiology (categorized as tumor (n=19), trauma (n=5), stroke (n=11), idiopathic epilepsy (n=33) and other (n=17)), previous number of AEDs, and changes in seizure control or subsequent seizure freedom. Data was evaluated in relation to efficacy across gender, age, seizure etiology, and first-line vs. conversion therapy., Of the patients immediately available for follow-up, thirty-nine remained on LEV for at least 6 months; twenty-five (64%) became seizure free. Of those continuing to experience refractory seizures, eight (57%) exhibited marked improvement in seizure control, five patients showed no change and one patient demonstrated worse seizure control. Expanding the patient population to at least 3 months on LEV (n= 57), thirty-eight (67%) were seizure free, and of the breakthrough patients, nine patients (47%) experienced improvement in seizure control while eleven showed no change or reduced control. The pediatric population ([lt]18 years) was found to consist of twenty-six patients (ages 8 months-16 years; mean 6.1 years), of which fifteen were available for follow-up after 6 months on LEV. Eight patients (53%%) became seizure free while two showed [gt]50% reduction in seizures and five (33%) showed no change in control. In comparison across age, this was less than the 63% seizure freedom noted in the age range of 18-65, and 88% in age 65 and older. In a 6 month evaluation across sexes, 87% of males achieved seizure freedom or marked improvement in control, compared to 81% females. We also observed dosing patterns (range: 20mg BID-1500mg BID, mode: 500mg BID) having direct proportionality to seizure frequency and severity, as well as age. It was noted that although a loading dose of 750mg is recommended, in only seven instances was a higher initial dose used when prescribed below the recommended loading level., Our results indicate that Levetiracetam as a monotherapy can provide an effective and tolerable treatment for a range of seizure disorders. A prospective, double blind study is necessary to confirm our finding., (Supported by UCB Pharmaceuticals.)