Abstracts

We describe the efficacy and tolerability of levetiracetam (LEV) versus carbamazepine (CBZ) in treatment of epileptic elderly patients., The population of the study is composed by 24 consecutive newly diagnosed outpatient, 14 males and 10 females, referred to our epilepsy centres because of at least two unprovoked seizures in last 12 months.
Each patient has performed a standard EEG, a brain MRI and a self-administered quality of life questionnaire (SF-36) at first visit. All patients have performed an EEG and a SF-36 questionnaire at 12 weeks, 24 weeks and at 48 weeks of follow up. We divided these patients in two groups: 12 patients out of 24 with LEV at dosage of 1000 mg a day (LEV group) and 12 patients out of 24 with CBZ at dosage of 600 mg a day (CBZ group). Both treatments have been used as monotherapy., 17 patients, 9 out of 17 including in LEV group and 8 out of 17 including in CBZ group, showed minimal MRI abnormalities consisting of point lacunar infarcts of white and/or grey matter of the brain.
9 out of 24 patients, 6 of LEV group and 3 of CBZ group, showed minimal EEG abnormalities at basal evaluation consisting of focal theta waves that have disappeared after 12 weeks of treatment in all patients.
All patients have been seizure-free for 48 weeks of follow up except 3 patients, 2 on CBZ and 1 on LEV that have presented a motor partial seizure: in these patients we have increased the dosage respectively to 800 mg a day and 1500 mg a day.
All LEV group have completed the follow up period remaining on original drug with a retention rate of 100%, while 3 patients of CBZ group have discontinued therapy for intolerable side effects: 2 patients showed marked somnolence and one patient showed dizziness. For this reason the retention rate of CBZ group has been 75%.
SF-36 findings showed a poor impact of treatment on quality of life in all LEV group, while data of CBZ group showed a light worsening in some items of the questionnaire in 4 out of 12 patients., Retention in the study has been significantly better for LEV than for CBZ. CBZ caused significantly more side effects than LEV, resulting in earlier termination of treatment. Optimal dose of both drugs may be lower in elderly compared with general epileptic population. The efficacy of LEV and CBZ is very similar, but the impact of drug on quality of life is perceived in pretty different manner by patients. Even though it is necessary a larger population, we believe that LEV should be considered as possible first-line therapy for new onset seizures in the elderly.,