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Levetiracetam: efficacy and tolerability in patients with childhood and adolescent absence seizures
S40 051EpiTP Levetiracetam: efficacy and tolerability in patients with childhood and adolescent absence seizures C. Cerminara1 , L. D’Argenzio1 , E. Compagnone1 , A. Lo Castro1 , M. Pinci1 , V. Bagnolo1 , N. Zamponi2 , M.G. Marciani1 , G. Coppola3 , P. Curatolo1 . 1 Department of Neuroscience, Tor Vergata University, Rome, Italy, 2 Department of Child Neurology and Psychiatry, Salesi Children-Hospital, Ancona, Italy, 3 Department of Child Neurology and Psychiatry, University of Naples, Italy Levetiracetam (LEV) is a new antiepileptic drug (AED), approved in 1999 as add-on therapy in patients with partial refractory seizures and seems to have an effect on primary generalized seizures. Not many studies have been published on the efficacy of LEV in childhood or adolescent absence epilepsy (CAE-JAE). The aim of our study is to evaluate efficacy and tolerability of LEV in an unselected group of patients with absence seizures. We have followed 15 patients (6F and 9M) with a mean age of 8.1 years at onset. Baseline seizure frequency ranged from 3 to >60 per day. Eight patients received LEV as de novo therapy while 7 as add-on therapy to valproate, lamotrigine, ethosuximide and phenobarbital. Therapeutic dose was between 1000 2000 mg/day. Treatment with LEV ranged from 3 to 24 months. Efficacy and tolerability of Levetiracetam was evaluated during every follow-up visit, using a questionnaire about adverse events, seizure diary and patients report At the last observation, 7 patients were “seizure free”, and one patient showed a reduction of seizure frequency of >75%, including 4 subjects treated with LEV monotherapy. Seizures frequency was unchanged in the remaining patients. Each patient underwent several Video EEG: the recording was normal in 8 patients while in the remaining 7 no changes were observed. Treatment with LEV was discontinued in 4 children because of migraine. Patients with absence seizures demonstrate a good response to firstline therapy, if appropriately selected. Our experience, even if on a small sample, seems to suggest that LEV can be effective and well tolerated in patients with CAE or JAE, controlling the hyperexcitability of the neuronal systems involved and reducing the associated EEG abnormalities. 052EpiTP Levetiracetam as add on for a patient with intractable primary generalized epilepsy with predominantly atypical absence type seizures. Case report D.A. Hasbini1 , W. Nasreddine2 , M. Mikati3 . 1 Division of Pediatric Neurology, Department of Pediatrics, Rafic Hariri University Hospital, Lebanon, 2 Division of Adult Neurology, Department of Internal Medicine, Rafic Hariri University Hospital, Beirut, Lebanon, 3 Professor and Chairman, Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon Intractable epilepsies remain nowadays a challenge for all neurologists. With the advent of the new generation antiepileptic medications however, the choice of drugs is now more variable than before and patients now can more and more benefit from them especially those with intractable epilepsies. We do report a nine years old girl who presented with idiopathic generalized epilepsy with predominantly atypical absence seizures that started since the age of three years and that was resistant to the most commonly used antiepileptic drugs including some of the new generation medications. However her seizures improved markedly upon adding Levetiracetam (Keppra) to her medications, that consisted of Valproic acid and Clonazepam. Her speech improved markedly and her condition became stable though not seizure free on an average dose of 25 mg/kg/day. We believe that Levetiracetam may provide hope for patients with intractable epilepsies and do encourage the physicians
Posters, Epilepsy Treatment (EpiT) to use new generation medications as Levetiracetam when the regular antiepileptic drugs alone fail to control the seizures. 053EpiTP Levetiracetam and steroids in epilepsies with continuous spikes and waves during slow sleep: a prospective study on 12 children P. Dimova, V. Bojinova. Clinic of Child Neurology, St. Naum University Hospital of Neurology and Psychiatry, Sofia, Bulgaria Purpose: To evaluate the efficacy of add-on levetiracetam (LEV) and steroids on EEG, seizures and neuropsychological functioning of children with continuous spikes and waves during slow sleep (CSWS). Methods: LEV at a daily dose of 40−60 mg/kg was added in 12 children with CSWS in the course of their idiopathic (n = 9) or symptomatic (n = 3) epilepsy. After 2 weeks of LEV treatment, if CSWS persisted or was only rated decreased, a short-term IV followed by one-month oral steroid therapy was used. The IV steroid therapy consisted of 3 cycles as follows: 3 days with 6 mg/kg body weight methylprednisolone alternating with 3 days off. Decreasing dexamethasone was used as subsequent oral steroid. Results: After 2 weeks of LEV treatment, only three patients (25%) showed CSWS abolishment and full seizure control. Two children (16.7%) demonstrated EEG improvement and >50% seizure reduction. Seven children (58.3%) had no EEG benefit and steroid treatment was introduced, while LEV was continued in 4, and discontinued in 3 of them due to adverse effects (agitation and aggression). Overall, 9 children (75%) received steroid treatment. They all showed complete CSWS cessation after IV and/or oral steroid application. Nine patients (75%) were still on LEV after 6 months and maintained the positive clinical and EEG effect. Conclusions: This small prospective study suggests that steroids act significantly better than LEV in the rapid abolishment of CSWS. LEV could be long-term used as addon treatment of children with CSWS and sustains the positive effect on the seizures, EEG, and neuropsychological functions achieved with steroid therapy. 054EpiTP Zonisamide efficacy in ESES: a case report C. Cerminara, L. D’Argenzio, E. D’Agati, A. Lo Castro, M. Rosso, V. Bagnolo, P. Curatolo. Department of Neuroscience, Tor Vergata University, Rome, Italy Electrical status epilepticus during sleep (ESES) is an epileptic syndrome with a peculiar EEG pattern and the association of various seizure types, partial or generalized. The aetiology of ESES is unknown and the clinical findings may include also a global or selective psychomotor impairment. Several anti-epileptic drugs (AEDs) have been used to treat seizures in ESES, but clinical improvement on cognitive, language and motor impairment is still matter of debate. Zonisamide (ZNS) is a novel AED that show a broad combination of complementary mechanisms of action and may exert neuroprotective actions. We report the case of young boy with ESES and attention deficit, who, after six months of ZNS treatment, presented an improvement of clinical and neuropsychological aspects. A 10-years-old boy was referred to our unit for the persistence of nocturnal motor seizures despite treatment with Valproate and Clobazam. Family history for epilepsy or neurologic disorders was negative. An awake-EEG revealed a continuous multifocal epileptic activity in fronto-temporal regions. Brain MRI was normal. Neuropsychological, cognitive and attentive performances were evaluated, and a 24 h-EEG revealed a continuous spike-wave activity during sleep, matching criteria for ESES. ZNS (2.5 mg/kg/die) was titrated as add-on therapy. After six months, the patient was re-evaluated and another 24h-EEG was performed.
Posters, Epilepsy Treatment (EpiT) to use new generation medications as Levetiracetam when the regular antiepileptic drugs alone fail to control the seizures. 053EpiTP Levetiracetam and steroids in epilepsies with continuous spikes and waves during slow sleep: a prospective study on 12 children P. Dimova, V. Bojinova. Clinic of Child Neurology, St. Naum University Hospital of Neurology and Psychiatry, Sofia, Bulgaria Purpose: To evaluate the efficacy of add-on levetiracetam (LEV) and steroids on EEG, seizures and neuropsychological functioning of children with continuous spikes and waves during slow sleep (CSWS). Methods: LEV at a daily dose of 40−60 mg/kg was added in 12 children with CSWS in the course of their idiopathic (n = 9) or symptomatic (n = 3) epilepsy. After 2 weeks of LEV treatment, if CSWS persisted or was only rated decreased, a short-term IV followed by one-month oral steroid therapy was used. The IV steroid therapy consisted of 3 cycles as follows: 3 days with 6 mg/kg body weight methylprednisolone alternating with 3 days off. Decreasing dexamethasone was used as subsequent oral steroid. Results: After 2 weeks of LEV treatment, only three patients (25%) showed CSWS abolishment and full seizure control. Two children (16.7%) demonstrated EEG improvement and >50% seizure reduction. Seven children (58.3%) had no EEG benefit and steroid treatment was introduced, while LEV was continued in 4, and discontinued in 3 of them due to adverse effects (agitation and aggression). Overall, 9 children (75%) received steroid treatment. They all showed complete CSWS cessation after IV and/or oral steroid application. Nine patients (75%) were still on LEV after 6 months and maintained the positive clinical and EEG effect. Conclusions: This small prospective study suggests that steroids act significantly better than LEV in the rapid abolishment of CSWS. LEV could be long-term used as addon treatment of children with CSWS and sustains the positive effect on the seizures, EEG, and neuropsychological functions achieved with steroid therapy. 054EpiTP Zonisamide efficacy in ESES: a case report C. Cerminara, L. D’Argenzio, E. D’Agati, A. Lo Castro, M. Rosso, V. Bagnolo, P. Curatolo. Department of Neuroscience, Tor Vergata University, Rome, Italy Electrical status epilepticus during sleep (ESES) is an epileptic syndrome with a peculiar EEG pattern and the association of various seizure types, partial or generalized. The aetiology of ESES is unknown and the clinical findings may include also a global or selective psychomotor impairment. Several anti-epileptic drugs (AEDs) have been used to treat seizures in ESES, but clinical improvement on cognitive, language and motor impairment is still matter of debate. Zonisamide (ZNS) is a novel AED that show a broad combination of complementary mechanisms of action and may exert neuroprotective actions. We report the case of young boy with ESES and attention deficit, who, after six months of ZNS treatment, presented an improvement of clinical and neuropsychological aspects. A 10-years-old boy was referred to our unit for the persistence of nocturnal motor seizures despite treatment with Valproate and Clobazam. Family history for epilepsy or neurologic disorders was negative. An awake-EEG revealed a continuous multifocal epileptic activity in fronto-temporal regions. Brain MRI was normal. Neuropsychological, cognitive and attentive performances were evaluated, and a 24 h-EEG revealed a continuous spike-wave activity during sleep, matching criteria for ESES. ZNS (2.5 mg/kg/die) was titrated as add-on therapy. After six months, the patient was re-evaluated and another 24h-EEG was performed.