摘要
Background: Levetiracetam (LEV) is a new antiepileptic drug with efficacy in p artial onset seizures. We report a case in which generalized onset absence sei zures responded clinically and electrographically to LEV. Methods: We evaluated with continuous video/electroencephalography an adult with generalized onset se izures given 3 antiepileptic drugs, 1 of which was LEV. Levetiracetam initiation 2 months before admission decreased patient reported seizures. Interictal elec troencephalography revealed generalized 3.5 Hz spike wave and polyspike wave discharges. Spike wave bursts lasting 2 seconds or longer caused a pause in con tinuous reading aloud, consistent with clinical absence seizures. Levetiracetam was discontinued on admission, lamotrigine was gradually discontinued across 2 d ays, and topiramate was not changed. One encephalographer counted from video/ele ctroencephalography recordings the number of spike wave bursts in 1 hour time samples that included wake and sleep time. Results: Spike wave bursts increased from 4 to 56 per hour at baseline (4000 mg of LEV per day) to 406 to 914 per hour less than 48 hours after LEV discontinuation. L evetiracetam treatment was restarted, and 3 hours after the first dose of 1000 m g, spike wave bursts dropped to 135 per hour. Response was sustained during the next 2 days. Conclusions: This case showed a dramatic, rapid effect of LEV disc ontinuation and reinstitution on generalized spikewave burst frequency and clini cal absence. The effects were independent of reduction of lamotrigine and withou t change in topiramate doses and occurred in a time course consistent with LEV p harmacokinetics. Levetiracetam may be effective in generalized onset epilepsy, and randomized, controlled trials are indicated.
Background: Levetiracetam (LEV) is a new antiepileptic drug with efficacy in p artial onset seizures. We report a case in which generalized onset absence sei zures responded clinically and electrographically to LEV. Methods: We evaluated with continuous video/electroencephalography an adult with generalized onset se izures given 3 antiepileptic drugs, 1 of which was LEV. Levetiracetam initiation 2 months before admission decreased patient reported seizures. Interictal elec troencephalography revealed generalized 3.5 Hz spike wave and polyspike wave discharges. Spike wave bursts lasting 2 seconds or longer caused a pause in con tinuous reading aloud, consistent with clinical absence seizures. Levetiracetam was discontinued on admission, lamotrigine was gradually discontinued across 2 d ays, and topiramate was not changed. One encephalographer counted from video/ele ctroencephalography recordings the number of spike wave bursts in 1 hour time samples that included wake and sleep time. Results: Spike wave bursts increased from 4 to 56 per hour at baseline (4000 mg of LEV per day) to 406 to 914 per hour less than 48 hours after LEV discontinuation. L evetiracetam treatment was restarted, and 3 hours after the first dose of 1000 m g, spike wave bursts dropped to 135 per hour. Response was sustained during the next 2 days. Conclusions: This case showed a dramatic, rapid effect of LEV disc ontinuation and reinstitution on generalized spikewave burst frequency and clini cal absence. The effects were independent of reduction of lamotrigine and withou t change in topiramate doses and occurred in a time course consistent with LEV p harmacokinetics. Levetiracetam may be effective in generalized onset epilepsy, and randomized, controlled trials are indicated.
出处
《世界核心医学期刊文摘（神经病学分册）》
2005年第3期17-18,共2页
Digest of the World Core Medical Journals:Clinical Neurology
