[Effectiveness and safety of long-term levetiracetam treatment in patients with refractory epilepsy].
OBJECTIVE
To evaluate the long-term effects and tolerability of levetiracetam (LEV) in refractory epilepsy.


METHODS
LEV was administered to 76 patients whose seizures were inadequately controlled by their current medications. The patients were followed for a minimum of 18 months but less than 2 years. The efficacy of LEV treatment was assessed retrospectively as the proportion of patients who experienced at least a 50% reduction in the frequency of seizures (50% RR), and adverse events were analyzed.


RESULTS
The 50% RR in all 76 patients was 42%. The 50% RRs in the 54 patients with localization-related epilepsy and in the 20 patients with generalized epilepsy were 42% and 35%, respectively. The patients who responded most remarkably to the therapy, with at least a 75% reduction in the frequency of seizures, were more often those with localization-related epilepsy. Among adverse events, irritability and hyperactivity/impulsivity were observed more frequently in this study than in previous reports. These events were observed predominantly in patients suffering from autism or attention deficit hyperactivity disorder (AD/HD) as a comorbidity. γ-GTP values were improved in 14 of 17 patients whose values prior to beginning LEV treatment were higher than the normal range. This beneficial effect presumably resulted from a dose reduction or the discontinuation of other hepatotoxic antiepileptic drugs.


CONCLUSIONS
LEV was useful for the treatment of refractory epilepsy, and long-term efficacy was demonstrated. LEV also appeared to be less hepatotoxic. Behavioral changes should be monitored carefully when LEV is administered to patients with concomitant autism or AD/HD.
Mitsuhiro
M
Matsuo
Akiko
A
Fuji
Tetsuo
T
Matsuzaka
Hiroshi
H
Baba
Keisuke
K
Toda
Tomonori
T
Ono
Shigeki
S
Tanaka
Tatsuharu
T
Sato
Hiroyuki
H
Moriuchi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D006801:Humans; D007223:Infant; D000077287:Levetiracetam; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010889:Piracetam / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam