Levetiracetam reduces frequency and duration of epileptic activity in patients with refractory primary generalized epilepsy.

PURPOSE: Levetiracetam (LEV) is a new antiepileptic drug highly effective as add-on treatment in refractory partial epilepsies. In animal models, LEV is effective against absence seizures. A limited number of case reports and series indicate that LEV reduces seizure frequency in patients with generalized epilepsies.

METHOD: We evaluated with continuous EEG eight adult patients with idiopathic generalized epilepsy (IGE). All patients were refractory to the conventional therapy for IGE. Four patients received LEV as add-on therapy, and in four, a conversion to LEV monotherapy was undergone. Epileptic activity was analyzed in order to determine spike-wave density as well as median and maximal duration of spike-wave discharges. Each patient underwent a 24h EEG baseline monitoring before starting LEV therapy. A second 24h EEG examination was performed after a mean follow-up period of 136 days.

RESULTS: Spike-wave density (spikes/h) was reduced by 78% after LEV administration. Median spike-wave duration decreased by 72% (p < 0.05). Maximal spike-wave duration was 6s before, and 1.5s after LEV with a percentage change of 81% (p < 0.05). The four patients on LEV monotherapy evidenced also a considerably improvement after conversion.

CONCLUSIONS: This study showed that LEV produces a consistent long-term reduction of interictal epileptic activity in patients with refractory IGE. The reduction in the spike-wave activity additionally correlated with a clinically relevant antiepileptic effect. Our results support the concept that LEV could be an alternative therapy in primary generalized epilepsies.