Levetiracetam monotherapy in elderly patients with epilepsy: efficacy and tolerability

Rationale: To evaluate efficacy, safety and tolerabilty of levetiracetam monotherapy in elderly patients with seizures. Methods: Eight elderly patients with onset of epilepsy after 65 years of age were included in the study. Seven were females and 1 male; age ranged from74 to 93 years.All patients suffered fromsymptomatic focal epilepsy, related to vascular encephalopathy in 6 and to degenerative dementia in 2; partial seizureswere observed in all patients,with secondary generalization in 3 cases. Six patients had been previously treated with antiepileptic (AED) drugs, which were discontinued after LEV titration: in 3 of these cases, seizures were uncontrolled by the AEDs used before adding LEV, while the other 3 were seizure free but showed severe side effects related to AED treatment. The remaining 2 patients were not treated at the time of the study and LEV was given as first-choice antiepileptic drug. The follow up period was at least six months in all patients. LEV oral dosage ranged from 1g to 2g/day. Laboratory parameters of liver and hematological function were evaluated in all patients after 1 month of LEV treatment and successively every 3 months. All patients were comedicated with non- AED drugs for treatment of various pathological conditions, mostly related to cardiovascular problems. Results: In all patients LEV showed a good tolerabilty without relevant side effects; in particular no unfavourable effects on cognitive state, sleep-wake cycle, and behavior were reported. No alterations of hepatic and hematologic parameters were observed. In the six patients in whom LEV substituted a previous AED treatment, LEV monotherapy resulted in improvement of cognitive functioning and daily performances, particularly relevant in 3 patients. In this subgroup of 6 subjects, 3 patients were already seizure free and did not show any recurrence of seizures with LEV monotherapy; another became seizure free with LEV treatment, and the remaining 2 showed a reduction of seizures > 50%. The 2 patients in whom LEV was given as the first choice drug showed a 50% reduction of seizures. Conclusions: Treatment of epilepsy in elderly patients may be par- ticularly difficult because of increased vulnerability of this population to adverse effects and increased risks of toxicity and unfavorable drugs interactions due to comedication. In our small sample, LEV has showed an optimal profile as an AED for elderly patients, associating efficacy, safety and good tolerability, with a considerable improvement of quality of life in patients and caregivers.