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Levetiracetam Efficacy in Refractory Partial‐onset Seizures, Especially after Failed Epilepsy Surgery
Author(s) -
Motamedi Mahmood,
Nguyen Dang K.,
Zaatreh Megdad,
Singh Sanjay P.,
Westerveld Michael,
Thompson James L.,
Mattson Richard,
Blumenfeld Hal,
Novotny Edward,
Spencer Susan S.
Publication year - 2003
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1046/j.1528-1157.2003.26302.x
Subject(s) - levetiracetam , discontinuation , epilepsy , medicine , refractory (planetary science) , epilepsy surgery , anesthesia , surgery , retrospective cohort study , anticonvulsant , psychiatry , physics , astrobiology
Summary: Purpose: We conducted a retrospective study to evaluate the efficacy of levetiracetam as adjunctive therapy in patients with localization‐related epilepsy, and specifically in the subset of patients for whom epilepsy surgery failed. Methods: Eighty‐two patients with uncontrolled partial‐onset seizures treated with levetiracetam were identified; epilepsy surgery had failed for 21 (25.6%; group I), and 61 (74.4%) had no prior surgery (group II). Group I and group II patients were comparable in age (mean, 40.7 vs. 41.5 years) and age at seizure onset (mean, 14.4 vs. 18.2 years). Patients who had ≥50% reduction in seizure frequency were considered responders; the remaining patients were considered nonresponders. Results: In patients (group I) for whom surgery had failed, responder rate was 76.1% (16 of 21), including 10 (47.6%) patients who became seizure free. In nonsurgical patients (group II), responder rate was 34.3% (21 of 61), including nine (14.7%) patients who became seizure free. In group I, 11 (91.6%) of 12 temporal resection patients were responders, of whom eight were seizure free; of the remaining nine operated (extratemporal) patients, five (55.5%) were responders, and two were seizure free. In three responders, all in group I, a severe, delayed psychotic syndrome developed 4 to 9 months after levetiracetam introduction, leading to its discontinuation. Conclusions: These findings suggest that adjunctive levetiracetam therapy should be considered early after failed epilepsy surgery, especially after temporal resection, and may have implications for its use before surgical intervention. Patients should be under close psychiatric observation in this clinical setting.