First North American Regional Epilepsy Congress
Levetiracetam as First-Line Therapy in Older Epileptic Patients
Speaker: Nicola Paciello, MD, Neurologist, Neuroscience Department, Neurology Unit, San Carlo Hospital, Potenza, Italy
Although the efficacy of levetiracetam (Keppra, UCB Pharma) (Canadian Tegretol, Novartis), which are both used as monotherapy, were comparable in preventing seizures in elderly patients with epilepsy, the retention of effect was significantly improved with levetiracetam, and quality of life was perceived to be better in the levetiracetam-treated patients.
Twenty-four elderly outpatients with newly diagnosed epilepsy were referred to the epilepsy center because of at least two unprovoked seizures in the previous 12 months. Each patient underwent standard electroencephalography (EEG) and brain magnetic resonance imaging (MRI). They also completed a self-administered 36-item Short-Form quality-of-life questionnaire (SF-36) at 12 weeks, 24 weeks, and 48 weeks of follow-up.
The patients were randomly divided into two groups: 12 patients received levetiracetam 1,000 mg/day, and 12 patients were given carbamazepine 600 mg/day.
Seventeen patients, nine receiving levetiracetam and eight receiving generic carbamazepine, showed minimal MRI abnormalities consisting of point lacunar infarcts of white and gray matter of the brain. Nine of the 24 patients (six receiving levetiracetam and three receiving carbamazepine) had minimal EEG abnormalities at the baseline evaluation. These abnormalities disappeared in all patients after 12 weeks of treatment.
Patients who received levetiracetam completed the follow-up period with the original drug, for a retention-of-effect rate of 100%. In the carbamazepine group, three patients discontinued therapy because of intolerable side effects, resulting in a retention rate of 75% and earlier termination of treatment.
The results suggested that the optimal dose of both drugs might be lower for elderly patients than for the general epileptic population.
Benefits of Carbamazepine in Children with Recent Partial-Onset Epilepsy
Speaker: Katherine D. Holland, MD, PhD, Assistant Professor of Pediatrics and Neurology, Division of Neurology, Cincinnati Children’s Hospital, Cincinnati, Ohio
Carbamazepine has been valuable in children with partial-onset epilepsy, with almost 55% of the children becoming seizure-free after starting monotherapy with this agent.
Because little is known about the effectiveness of anti-epileptic drug therapy and dosages in children, a study was conducted to examine the responses to treatment in children with newly diagnosed epilepsy who were given carbamazepine as a single anticonvulsant agent.
A cohort of 100 children (1 to 18 years of age) from the New-Onset Seizure Clinic at the Cincinnati Children’s Hospital were given carbamazepine as initial monotherapy. The investigators used information from the history, physical examination, MRI, and EEG to classify the type of epilepsy and its etiology.
Seizure control, adherence, and adverse events were recorded at each visit. Response was defined as freedom from seizures for at least 12 months with a stable dose of carbamazepine or the occurrence of breakthrough seizures caused solely by missed doses.
Of the 100 patients in the study, 55 children became seizure-free. Of the remaining 45 children, 10 did not tolerate the drug within the first three months because of hypersensitivity or severe adverse effects; 35 patients continued to have seizures.
The mean dose of carbamazepine in the seizure-free children was 11.1 mg/kg per day, and most of these children responded at the initial dose. There was a weak but significant correlation between age at the inception of treatment and the dose that was used to control seizures.
For the 44 children under 12 years of age who became seizure-free, the average daily dose was 11.8 ± 3.4 mg/kg per day.
For the 11 children 12 years of age or older who became seizure-free, the average daily dose was 9 ± 3.4 mg/kg per day.
Children under 12 years of age who continued to have seizures with doses of carbamazepine over 17.5 mg/kg per day and those older than 12 years of age who continued to have seizures with 15 mg/kg per day were unlikely to respond to the monotherapy.