Levetiracetam induces a rapid and sustained reduction of generalized spike-wave and clinical absence.

Abstract

BACKGROUND:

Levetiracetam (LEV) is a new antiepileptic drug with efficacy in partial-onset seizures. We report a case in which generalized-onset absence seizures responded clinically and electrographically to LEV.

METHODS:

We evaluated with continuous video/electroencephalography an adult with generalized-onset seizures given 3 antiepileptic drugs, 1 of which was LEV. Levetiracetam initiation 2 months before admission decreased patient-reported seizures. Interictal electroencephalography revealed generalized 3.5-Hz spike-wave and polyspike-wave discharges. Spike-wave bursts lasting 2 seconds or longer caused a pause in continuous reading aloud, consistent with clinical absence seizures. Levetiracetam was discontinued on admission, lamotrigine was gradually discontinued across 2 days, and topiramate was not changed. One encephalographer counted from video/electroencephalography recordings the number of spike-wave bursts in 1-hour time samples that included wake and sleep time.

RESULTS:

Spike-wave bursts increased from 4 to 56 per hour at baseline (4000 mg of LEV per day) to 406 to 914 per hour less than 48 hours after LEV discontinuation. Levetiracetam treatment was restarted, and 3 hours after the first dose of 1000 mg, spike-wave bursts dropped to 135 per hour. Response was sustained during the next 2 days.

CONCLUSIONS:

This case showed a dramatic, rapid effect of LEV discontinuation and reinstitution on generalized spike-wave burst frequency and clinical absence. The effects were independent of reduction of lamotrigine and without change in topiramate doses and occurred in a time course consistent with LEV pharmacokinetics. Levetiracetam may be effective in generalized-onset epilepsy, and randomized, controlled trials are indicated.

• Authors: Jennifer Cavitt, Michael Privitera
• Journal: Archives of neurology (Arch Neurol) Vol. 61 Issue 10 Pg. 1604-7 (Oct 2004) ISSN: 0003-9942 [Print] United States
• PMID: 15477517 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anticonvulsants
• Triazines
• Topiramate
• Fructose
• Levetiracetam
• Lamotrigine
• Piracetam

Topics

• Adult
• Anticonvulsants (therapeutic use)
• Delta Rhythm (drug effects)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Electroencephalography (drug effects)
• Female
• Fructose (analogs & derivatives, therapeutic use)
• Humans
• Lamotrigine
• Levetiracetam
• Piracetam (analogs & derivatives, therapeutic use)
• Retrospective Studies
• Seizures (drug therapy, physiopathology)
• Topiramate
• Triazines (therapeutic use)