Abstracts

Levetiracetam (LEV) is an antiepileptic drug (AED) approved as add-on therapy in the treatment of partial onset seizures in adults with epilepsy. It has a rapid onset of action, though its effectiveness in the treatment of repetitive seizures or status epilepticus is unknown. This study reports the acute use of LEV in hospitalized, EEG monitored patients with recurrent seizures. We retrospectively identified adults who underwent continuous scalp EEG monitoring at Washington University from 1/02 to 5/04, were diagnosed with nonconvulsive, partial status epilepticus or frequent seizures ([gt]1/hour) and were given LEV during the recording. Patients who previously had taken LEV were not included. The mean age at the time of monitoring was 54.8 years (range: 19-81 years). Seventeen patients were identified who were given LEV for acute treatment of seizures. Sixteen (94.1%) were given benzodiazepines including lorazepam and midazolam. Fourteen (82.4%) were treated with phenytoin (PHT) and 7 (41.2%) with valproate (VPA). Three patients received LEV as a primary AED during EEG monitoring without PHT or VPA. These cases are reported.
Case 1: A 77-year old woman with a history of dementia and seizures on carbamazepine (CBZ) monotherapy was admitted with new aphasia, disorientation and right sided weakness. Neuroimaging was unrevealing, and EEG showed left temporal seizures occurring initially every 3-6 minutes without clear changes in baseline behavior. Rapidly escalating doses of LEV to 2000mg BID were started initially with maintenance CBZ. Increasing seizure free periods were noted, and by hospital day #4, the patient remained seizure free.
Case 2: A 60-year old man presented with a 4 day history of confusion and difficulty speaking. A seizure was witnessed after outside hospital admission, and he was treated with lorazepam and PHT loading. He was transferred because of continued confusion, and EEG initially revealed posterior onset seizures every 10-40 minutes. He was started on LEV to a dose of 1500mg BID and given 2 total doses of lorazepam after which the seizures did not recur and mental status returned to baseline.
Case 3: A 60-year old woman with a history of subarachnoid hemorrhage and PHT allergy had been admitted with sepsis. She was maintained on a ventilator with intermittent midazolam for agitation. She had a witnessed generalized tonic-clonic seizure, and EEG revealed ongoing right frontopolar electrographic seizures. She was treated with lorazepam and started on LEV to a dose of 1000mg BID with resolution of seizures on EEG and no clinical recurrence. LEV may be an effective treatment as adjunctive therapy in the acute management of patients with frequent partial seizures or partial status epilepticus.