Levetiracetam in clinical practice: preliminary data in patients with different epilepsy syndromes.

Rationale: Levetiracetam (LEV) is a newantiepileptic drug (AED) indicated as adjunctive therapy in the treatment of partial and primary generalized seizures. Recent studies suggest its efficacy also as monotherapy. In this retrospective study we evaluated efficacy and tolerability of LEV in patients with different epilepsy syndromes. Methods: In this preliminary study we evaluated only epileptic pa- tients seen in our outpatients facilities in the last 6 months. All patients with present or past exposure to LEV were included, independently from duration of LEV therapy. However, efficacy of LEV treatment was evaluated only in patients who had received LEV for at least 6 months after titration. Tolerability of LEV therapy was evaluated in all patients. Demographic and clinical data were evaluated retrospectively from clinical charts and patients diaries. 83 patients were included in the study; 40 were males and 43 females, with age 7- 81 years. 21 patients were affected by Idiopathic Generalized Epilepsy (IGE), 4 by Symptomatic Generalized Epilepsy, 1 by Idiopathic Focal Epilepsy, 18 by Cryptogenic Focal Epilepsy (CFE) and 39 by Symptomatic Focal Epilepsy (SFE). 63 patients were drug resistant and received LEV with the aim of improving seizure control (Drug Resistant group, DR). 15 patients already had complete seizure control with AED therapy, but reported severe adverseeffects related to treatment: in these subjects LEV was introduced with the aim of reducing or withdrawing previous AED treatment (Adverse Effects group, AE). In the remaining 5 patients, who were not treated with AEDs, LEV was used as first line drug because of its favorable profile (De Novo group, DN). Patients who received LEV for a minimum of 6 months were considered responders when showing a > 50% reduction in seizures frequency and non responders when seizures frequency was unchanged, worsened or showed a reduction < 50%. Response to LEV therapy was evaluated separately in DR, AE and DN patients. Moreover, in DR patients response to therapy was evaluated separately according to epilepsy type. Results: 9 patients did not complete 6 months of LEV therapy and dropped out, because of adverse effects in 8 cases and of worsening of seizures in 1. Of the 74 patients treated for at least 6 months,59% were responders,with 35% seizure free(SF).In particular,in AE group 93% preserved seizure freedom on LEV treatment, with only 1 patient non responder. Predictably,the worst results were observed in the DR group, with 48% responders and in particular 18% SF.When DR patients were divided according to epilepsy type,IGE showed the highest percentages of responders,with 60%responders (2/3 SF),while SFE showed theworst results with 41% of responders and 10% SF. Conclusions: Our preliminary retrospective study shows LEV as a well tolerated and effective treatment.Efficacy seems to bemore relevant in patients with IGE,even when DR with previous treatment.