Abstracts

Rationale: Status epilepticus (SE) and seizure clusters are emergency situations, which require immediate and effective treatment. To date, intravenous (IV) benzodiazepines (BZD), IV phenytoin (PHE) and IV valproic acid (VPA) are widely used antiepileptic drug (AED) therapies in these situations. This study aimed to investigate the efficacy and tolerability of IV levetiracetam (LEV) in the treatment of SE and seizure clusters. Methods: We prospectively registered all patients treated with IV LEV between August 2006 and February 2008 and analyzed their clinical data and outcomes retrospectively. Indications for IV LEV were (1) premonitory SE with seizure clustering in 18 patients (rapid titration group, in 16/18 triggered by AED reduction during video-EEG monitoring), (2) non-convulsive SE (NCSE) refractory to standard first-line therapy (i.e. IV BZD, IV PHE or IV VPA) in 12 patients, and (3) IV LEV rapid loading after successful treatment of NCSE with IV BZD in ten patients. Doses, treatment response and adverse events were retrospectively evaluated. Results: Forty patients (21 men, median age 54±29 years) treated consecutively with IV LEV were analyzed. Twenty-one of 40 patients had a previous history of seizures. The patients were initially loaded with a mean bolus dose of 962±177mg (range 500-1500mg) IV LEV; the mean maintenance dose over the next 24 hours was 1000±623mg IV LEV. All patients received oral LEV after treatment with IV LEV. Outcome: In 17/18 (94%) patients, IV LEV was effective in terminating seizure clusters, in one patient, seizure reduction was >75 %. NCSE was terminated with IV LEV in 7/12 (58%) patients after the initial dose (i.e. in less than 15 minutes). In three patients, seizures did not subside with IV LEV and the patients received other consecutive IV AED therapies (IV VPA, IV PHE), two of them were resistant to all therapeutic attempts. In ten patients with rapid loading after NCSE, no relapses occurred following treatment with IV LEV. IV LEV was very well tolerated and there were no systemic effects and local reactions observed. Conclusions: These data suggest that IV LEV may be used as a safe and effective alternative to standard IV AED treatments for acute seizure emergency situations. Randomized controlled trials are necessary to estimate the full potential of LEV IV in the emergency treatment.