LEVETIRACETAM FOR THE TREATMENT OF “NOT SO BENIGN” IDIOPATHIC PARTIAL EPILEPSIES OF CHILDHOOD

Objectives: Virtually every antiepileptic drug (AED) is efficacious in benign partial epilepsy with centrotemporal spikes (BECTS), although the only randomised trials are with gabapentin (GBP) and sulthiame (STM). Some AEDs, however, among them carbamazepine (CBZ), oxcarbazepine (OCB) and lamotrigine (LTG) have been reported to worsen clinical and EEG features. Decrease in cognitive performance and/or deviance in behaviour seem to be associated with progression in EEG abnormalities. AEDs with reported positive – although often only transient – effect on EEG spikes are STM, clobazame (CLB) and ethosuximide (ESX). However, with the exception of STM, frequent intolerable side effects minimize their treatment potential in BECTS. Levetiracetam (LEV) has been reported to be effective and safe in different epilepsy syndromes of childhood onset. The aim of this ongoing study is therefore to define the efficacy and safety of LEV in children with BECTS and to assess its effect on interictal EEG and cognition. We present pilot data on fifteen children.

Methods: Children with BECTS are recruited from the paediatric epilepsy outpatient department. Comprehensive neuropsychological assessments are conducted before treatment and then periodically. First-line AED remains sulthiame. In case of EEG worsening associated with cognitive involvement, LEV is administered. Titration is in weekly increments of 10mg/kg body weight, until the appearance of side effects. In case of treatment success, STM is tapered. Study endpoints are the electroclinical state and cognitive and/or behavioural performance after 12 months' continuous treatment with LEV monotherapy.

Results: 15 patients (9 boys and 6 girls, aged 6.3 to 11.1 years) were analysed for this report. Data so far demonstrate that all of these children remained seizure-free and are experiencing no reported side effects. In two cases, non-convulsive status epilepticus (oromotor dyspraxia with speech deterioration and drooling) was promptly interrupted. EEG spikes diminished and did not re-occur so far, no further cognitive or behavioural decline has been found.

Conclusion: LEV seems to be an effective and save alternative treatment option to STM in children with BECTS.