Abstract
Objectives: Levetiracetam (LEV) is a new antiepileptic drug (AED), which has a mechanism of action distinct from that of other AEDs suggesting a potentially valuable therapeutic profile. Our objective is to report our experience in treating children with intractable epilepsy.
Methods: Prospective, open label, add on trial of LEV in treating consecutive children with intractable epilepsy (defined as recurrent seizures after at least 3 antiepileptic medication trials). Follow up by one pediatric neurologist was performed. Therapeutic response was recorded as complete (no seizures), Good (> 50% seizure reduction), fair (< 50% seizure reduction), or none.
Results: Thirty children (58% males) aged 15 months - 15 years (mean 5.8 y, SD 3.9) were included. Most children (80%) had daily seizures, were tried on multiple AEDs (mean 4.7, SD 1.5), and had cognitive deficits (86%). The epilepsy was symptomatic in 64%. The mean LEV dose was 41 mg/kg/day and the children were followed for 4-8 months (median 5, SD 2.5). After the introduction of LEV, 6 (20%) children became completely seizure free and 43% had > 50% seizure reduction. The percentage of children with daily seizure was reduced from 80% before LEV to 27% afterward (p < 0.0001). Side effects were reported in 10 (33%) children in the form of decreased appetite, irritability, sedation, and seizure worsening. The majority were transient, however, LEV had to be withdrawn in four (13%) children because of lack of efficacy or seizure worsening.
Conclusions: Levetiracetam is a novel antiepileptic drug with a broad spectrum of antiepileptic efficacy. The drug was well tolerated and most side effects were transient. However, larger controlled studies are needed in young children to establish the long term efficacy and safety.