Levetiracetam in the treatment of epilepsy

BACKGROUND A proportion of patients with epilepsy are still without seizure control. This open study aims to evaluate the effect and tolerability in consecutive patients treated with the new antiepileptic drug levetiracetam. MATERIALS AND METHODS 184 adult patients were followed up for an average period of 8.1 months. 166 patients (90%) had refractory epilepsy, defined as having seizures more than once a month despite having tried at least two antiepileptic drugs. RESULTS 64 (39%) of the patients with refractory epilepsy had at least a 50% reduction of seizure frequency. Of these, 16 (10%) became seizure free. 24 (15%) had at least a 25% increase in seizure frequency. The overall effect was not significantly different for patients with and without learning disability. Levetiracetam also had promising effects in patients with juvenile myoclonic epilepsy and Lennox-Gastaut syndrome. Side effects were reported by 88 (44%) of all patients. Only 10 (5%) discontinued levetiracetam because of side effects. Behavioural effects were more frequent in patients with learning disability. INTERPRETATION Levetiracetam was well tolerated and effective as add-on treatment in partial and generalised seizures. Some patients experienced an increase in seizure. A possible favourable pharmacodynamic interaction between levetiracetam and carbamazepine should be further explored.