Abstracts

Rationale: Behavioural abnormalities and psychiatric adverse effects are not rare under antiepileptic therapy with Levetiracetam (18-36%). Incidence is predominant during the titration period suggesting that the titration protocol could be crucial for the tolerability. In our study we wanted to evaluate the influence of slow titration of Levetiracetam on the incidence of psychiatric adverse effects in a high risk group. Methods: We report 48 consecutive patients with drug-resistant epilepsies and psychiatric comorbidity or intellectual disability, who received LEV as add on-therapy (target dose: 1000-3000mg). In a first group of 15 patients LEV was titrated following a standard protocol (+500mg / 5 days). In the following second group of 33 patients LEV was titrated slowly (+125-250mg / 7 days). There were no significant differences between both groups in distribution of comorbidity and target doses. Incidence of psychiatric adverse effects was assessed during a follow up period of at least 3 months. Results: The incidence of psychiatric adverse effects in the standard titration group (9/15, 73,3 %) was significantly higher than in the slow titration group (2/33, 6,1%; p < 0,001, Fisher’s Exact Test, 2-tailed). Conclusions: Our data suggest that the incidence of psychiatric adverse effects of LEV can be remarkably reduced by slow titration. This approach makes its use safer in patients at high risk. Slow titration of LEV showed even better tolerability in this group than in unselected patients under a standard titration protocol. Further studies are needed to evaluate if slower titration of LEV should be recommended in general.