title: Levetiracetam efficacy in refractory partial-onset seizures, especially after failed epilepsy surgery.
abstract: OBJECTIVE
  We conducted a retrospective study to evaluate the efficacy of levetiracetam as adjunctive therapy in patients with localization-related epilepsy, and specifically in the subset of patients for whom epilepsy surgery failed.
  
  
  METHODS
  Eighty-two patients with uncontrolled partial-onset seizures treated with levetiracetam were identified; epilepsy surgery had failed for 21 (25.6%; group I), and 61 (74.4%) had no prior surgery (group II). Group I and group II patients were comparable in age (mean, 40.7 vs. 41.5 years) and age at seizure onset (mean, 14.4 vs. 18.2 years). Patients who had >/=50% reduction in seizure frequency were considered responders; the remaining patients were considered nonresponders.
  
  
  RESULTS
  In patients (group I) for whom surgery had failed, responder rate was 76.1% (16 of 21), including 10 (47.6%) patients who became seizure free. In nonsurgical patients (group II), responder rate was 34.3% (21 of 61), including nine (14.7%) patients who became seizure free. In group I, 11 (91.6%) of 12 temporal resection patients were responders, of whom eight were seizure free; of the remaining nine operated (extratemporal) patients, five (55.5%) were responders, and two were seizure free. In three responders, all in group I, a severe, delayed psychotic syndrome developed 4 to 9 months after levetiracetam introduction, leading to its discontinuation.
  
  
  CONCLUSIONS
  These findings suggest that adjunctive levetiracetam therapy should be considered early after failed epilepsy surgery, especially after temporal resection, and may have implications for its use before surgical intervention. Patients should be under close psychiatric observation in this clinical setting.
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06520, U.S.A.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Motamedi
authors.forename: Dang K
authors.initials: DK
authors.lastname: Nguyen
authors.forename: Megdad
authors.initials: M
authors.lastname: Zaatreh
authors.forename: Sanjay P
authors.initials: SP
authors.lastname: Singh
authors.forename: Michael
authors.initials: M
authors.lastname: Westerveld
authors.forename: James L
authors.initials: JL
authors.lastname: Thompson
authors.forename: Richard
authors.initials: R
authors.lastname: Mattson
authors.forename: Hal
authors.initials: H
authors.lastname: Blumenfeld
authors.forename: Edward
authors.initials: E
authors.lastname: Novotny
authors.forename: Susan S
authors.initials: SS
authors.lastname: Spencer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004569:Electroencephalography / Q000187:drug effects; D004828:Epilepsies, Partial / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010889:Piracetam / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000601:surgery; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam