A pilot trial of levetiracetam in eyelid myoclonia with absences (Jeavons syndrome).
OBJECTIVE
Eyelid myoclonia with absences (EMA) or Jeavons syndrome characterized by eyelid myoclonia (EM) (with or without absences), eye closure-induced EEG paroxysms, and photosensitivity. We conducted an open-label trial of levetiracetam in EMA.


METHODS
Patients were recruited in different Italian Epilepsy Centres. Levetiracetam was administrated at starting dose of 10 mg/kg/day up to 50-60 mg/kg/day in two doses. Treatment period included a 5-6 week up-titration phase and a 12-week evaluation phase. The number of days with EM (i.e., days with seizures, DwS) and number of generalized tonic-clonic seizures (GTCS) were evaluated. Analysis of intent-to-treat population was performed using Fisher's and Wilcoxon tests.


RESULTS
Thirty-five patients (23 F) with a mean age of 19 +/- 6 years were recruited. Twenty-seven had previously undergone one to five adequate trials of antiepileptic drugs. The median number of DwS/month was 12 +/- 8.2. Twenty-one patients experienced GTCS (median number/month: 1 +/- 0.2). Thirty-four subjects completed the trial. Levetiracetam was well tolerated (mean dose: 1985 mg/day). Responders were 28/35 (80%) patients, nine taking levetiracetam as monotherapy. Six patients were seizure-free, 15 had > or =75% and seven >50% seizure reduction. GTCS remitted in 14 out of 21 (66.6%) patients. The number/month of DwS (median: 12 vs 5; p = 0.0001) and of GTCS (median: 1 vs 0; p = 0.0001) decreased compared to baseline period. Disappearance or clear reduction in paroxysmal abnormalities at eye closure occurred in 20 of the responders and photoparoxysmal response in 19. Mean follow-up was 23.9 +/- 18.5 months.


CONCLUSIONS
Levetiracetam is effective and well tolerated in EMA. Placebo-controlled studies should confirm these findings.
Striano
Pasquale
P
Epilepsy Center, Department of Neurological Sciences, Federico II University, Napoli, Italy. pstriano@email.it
Sofia
Vito
V
Capovilla
Giuseppe
G
Rubboli
Guido
G
Di Bonaventura
Carlo
C
Coppola
Antonietta
A
Vitale
Giuseppina
G
Fontanillas
Luis
L
Giallonardo
Anna Teresa
AT
Biondi
Roberto
R
Romeo
Antonino
A
Viri
Maurizio
M
Zara
Federico
F
Striano
Salvatore
S
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D004359:Drug Therapy, Combination; D004831:Epilepsies, Myoclonic / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D004832:Epilepsy, Absence / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D020195:Epilepsy, Reflex / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D005143:Eyelids / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D009207:Myoclonus / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D010865:Pilot Projects; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013577:Syndrome; D016896:Treatment Outcome
D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam