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Levetiracetam a Promising Choice of Antiepileptic Drug in the Elderly: Presented at AES

By Fran Lowry

WASHINGTON, DC -- December 9, 2005 -- The antiepileptic drug levetiracetam appears to be particularly promising in elderly patients because of its relatively benign side effect profile and its lack of interaction with other medications, researchers said at the 59^th Annual Meeting of the American Society of Epilepsy (AES).

Patrick L. Alore, MD, Researcher, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, United States, and colleagues reviewed the use of levetiracetam in 39 patients aged 65 and older who received the drug while admitted to Loyola University Medical Center in 2004.

The researchers reviewed the use of levetiracetam to determine the indication for use, etiology of seizures, its use in an intensive care unit as opposed to a general ward setting, as first-line therapy, numbers of concomitant medications, co-existing anticonvulsant therapy, and dose range.

"Levetiracetam is a newer anticonvulsant with several pharmacological properties which favor its use in the elderly, particularly in a hospital based population with multiple medical co-morbidities," Dr. Alore said in his presentation on December 5^th.

"The compound is renally excreted, non-protein bound, it neither inhibits nor induces liver enzymes and steady state concentrations are achieved quickly, permitting early hospital discharge," he said. "Moreover, it is highly water soluble, which allows us to give it via a nasogastric tube, another benefit in elderly patients," he added.

Dr. Alore and his colleagues identified a total of 75 patients with a mean age of 74.9 years (range 65-98 years). Of the 73 patients in whom seizure type was known, 70 had focal epilepsy and three had generalized epilepsy.

The results of the review showed that there was a "striking" divergence in the use of levetiracetam compared with the general population of patients receiving anticonvulsants, Dr. Alore said.

A total of 54% of patients received levetiracetam while admitted to a neurosurgery or trauma service. The most common underlying cause of seizure was intracranial hemorrhage, particularly subdural hemorrhage. In addition, 80% received levetiracetam as first-line monotherapy, and had not been exposed to previous anticonvulsant use.

The most common setting for initiation of levetiracetam therapy was in an intensive care unit setting. The starting dose was 500 mg twice daily in 85% of patients and the average number of medications being taken at discharge was 9.4 (range 4 to 8 prescriptions).

Only 12% of patients who received levetiracetam had been taking another anticonvulsant, with phenytoin being the antiepileptic most commonly used.

"The pattern of use that we found indicates that levetiracetam as monotherapy is frequently used in the intensive care unit setting, particularly in neurosurgical patients," Dr. Alore said.

"It is a very attractive alternative in a population where the average number of medications taken is so considerable because of its lack of interaction with other drugs," he said. "In addition, relatively low doses are effective and patients continued to take their initial dose of 500 mg twice a day when we followed up."

"So I think that levetiracetam provides a valuable option for the treatment of seizures in an elderly, hospital-based population," he concluded.


[Presentation title: Use of Levetiracetam in an Elderly Hospital-Based Patient Population. Abstract 2.230]

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