Levetiracetam efficacy in epileptic syndromes with continuous spikes and waves during slow sleep: experience in 12 cases.
OBJECTIVE
To assess the add-on efficacy of levetiracetam on the EEG, behavior, and cognition of children with continuous spikes and waves during slow sleep (CSWS).


METHODS
Charts of children with behavioral and/or cognitive deterioration associated with CSWS who received levetiracetam at 50 mg/kg/day as add-on treatment were retrospectively reviewed. Awake and sleep EEG recordings and detailed neuropsychological and behavioral assessments were available at baseline and 2 months after levetiracetam initiation. In children showing clinical and/or electrophysiological improvement after 2 months, levetiracetam was continued with a new evaluation at 1 year.


RESULTS
Twelve patients were included (9 cryptogenic and 3 symptomatic cases). Seven patients (58.3%) showed improvement of EEG record. Among these seven patients, neuropsychological evaluation was improved in three, and in the other four patients, not testable because of severe cognitive impairment, behavior was improved. Two patients improved in neuropsychological evaluation despite the lack of EEG improvement. Eight patients (66.6%) continued levetiracetam treatment after 2 months. After 1 year, four patients were still on levetiracetam, two because sustained effect on EEG and behavior and the two others because improvement in neuropsychological testing despite unchanged EEG. Levetiracetam was discontinued in the other four patients because of neuropsychological or behavioral deterioration associated with CSWS pattern, between 9 and 11 months after treatment initiation.


CONCLUSIONS
This retrospective study suggests that levetiracetam has a positive effect on the EEG, the behavior, and the cognition of patients with epilepsy and CSWS. Additional studies are warranted in order to assess the place of this drug in these epileptic conditions.
Aeby
Alec
A
Department of Pediatric Neurology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium. alec.aeby@ulb.ac.be
Poznanski
Nathalie
N
Verheulpen
Denis
D
Wetzburger
Catherine
C
Van Bogaert
Patrick
P
D000293:Adolescent; D000927:Anticonvulsants / Q000494:pharmacology / Q000627:therapeutic use*; D002540:Cerebral Cortex / Q000187:drug effects / Q000503:physiopathology*; D002648:Child; D002653:Child Behavior Disorders / Q000188:drug therapy / Q000453:epidemiology; D002675:Child, Preschool; D003072:Cognition Disorders / Q000188:drug therapy / Q000453:epidemiology; D015897:Comorbidity; D004569:Electroencephalography / Q000187:drug effects* / Q000706:statistics & numerical data; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D009483:Neuropsychological Tests; D010889:Piracetam / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D012894:Sleep Stages / Q000187:drug effects / Q000502:physiology; D013577:Syndrome; D016896:Treatment Outcome
D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam