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Intravenous Levetiracetam an Effective Second-Line Therapy for Status Epilepticus: Presented at ECE (Epilepsy)

By Thomas S. May

RHODES, Greece -- July 3, 2010 -- Moderate doses of intravenous levetiracetam represent an efficacious and well-tolerated alternative for the treatment of some types of status epilepticus (SE), researchers said here at the 9th European Congress on Epileptology (ECE).

"Status epilepticus is a neurological emergency, with a mortality rate of up to 26%," said Steffen Eue, MD, Klinikum Bernburg, Bernburg, Germany, on June 30.

Levetiracetam was given as second-line therapy after benzodiazepines (lorazepam 2-6 mg or diazepam 5-10 mg) to 60 patients (29 men, 31 women; mean age 70 yrs) between 2006 and 2009.

Levetiracetam 1,000, 2,000 or 3,000 mg was administered as a 15-minute infusion (1,000 mg in 100 mL NaCl 0.9%) or as fractionated injections (500 mg in 20 mL NaCl 0.9%, given 2 or 4 times) depending on the type of SE. "The faster application form was used for convulsive types of SE, because of the increased danger to patients, especially with generalised convulsive status," said Dr. Eue.

The researchers used termination of SE to determine the efficacy of the treatment, while tolerability was assessed by evaluating treatment-related adverse events.

The investigators found that the administration of levetiracetam resulted in the termination of SE in 31 patients (51.1%). Of the 31 patients that were successfully treated, 22 had newly diagnosed epilepsy, Dr. Eue noted. "Only 5 of 27 patients with newly diagnosed epilepsy did not benefit from levetiracetam treatment," he said.

Levetiracetam was more effective in terminating simple partial (7/12) and complex partial (16/25) SE than nonconvulsive (5/11) or subtle (1/2) SE, and it was most effective in the treatment of myoclonic (2/2) SE. For the treatment of generalised tonic-clonic SE, levetiracetam was not sufficient to terminate SE in any of the patients (0/8).

Intravenous levetiracetam was generally well tolerated and no severe adverse events were reported.

Funding for this study was provided by UCB, Inc.

[Presentation title: Three Years in the Treatment of Status Epilepticus With Intravenous Levetiracetam. Abstract 157]

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