Levetiracitam: Exacerbation of Epilepsy
Abstract number :
3.113
Submission category :
Year :
2001
Submission ID :
2197
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
J.L. Goldstein, MD, Neurology, St. Louis Children[ssquote]s Hospital, St. Louis, MO; E.. Trevathan, MD, MPH, Neurology / Pediatrics, Washington University, St. Louis, MO; S.T. Arnold, MD, Neurology / Pediatrics, Washington University, St. Louis, MO; W.E.
RATIONALE: It is not known if levetiracitam (LEV) is one of the anti-epileptic drugs (AED)that exacerbates primary generalized seizures.
METHODS: We retrospectively reviewed all medical records in the Division of Pediatric Neurology of patients who had been started on LEV from 1999 to 2001. We determined seizure frequencies both before and after initiation of LEV, as well as EEG findings, type of epilepsy, age of onset of epilepsy, current age, other AEDs, and subjective comments of parents.
RESULTS: Thirty-four patients were started on LEV (ages 3 to 35 years, mean 15.2 years). 18 of the patients were female. 26 patients had complex partial seizures (with or without secondary generalization), 3 had multiple seizure types including generalized seizures, 3 had tonic or tonic-clonic seizures, one had myoclonic seizures, 1 had atypical absence seizures. The pre-LEV EEG findings were: 21 with a focal or multifocal abnormalities, 6 had generalized abnormalities, 3 were normal, 1 was borderline, 2 had only background abnomralities, and 1 had no EEG at St. Louis Childrens Hospital. All patients had been treated with at least one AED and most had been on multiple previous AEDs. Of our 34 patients, 7 (20.6 %) had some worsening of their seizure frequency, duration, or intensity after initiation of this medication. 2 of the patients developed new clinical drop attacks, which had not been present prior to the medication. Importantly, 4 of the 6 patients with generalized abnormalities on EEG had some worsening of seizures. The EEG findings in the patients who worsened (7 patients) were as follows: four had generalized epileptiform changes, one was normal, one had focal spikes, and one had a pattern that was difficult to characterize. Of the patients who worsened one had generalized spasms, three had multiple seizure types including generalized seizures, two had complex partial seizures, and one had only generalized tonic-clonic seizures.
CONCLUSIONS: In our series of 34 patients treated with levetiracitam, one fifth demonstrated some worsening of seizures. Primary generalized epileptiform abnormalities on EEG may predict exacerbation.