LEVETIRACETAM AS INITIAL MONOTHERAPHY FOR IDIOPATHIC GENERALIZED EPILEPSY

Objectives: Levetiracetam (LEV) is a novel antiepileptic drug; its mechanism of action is still unknown. Recent studies suggest that its mechanism of action is probably linked to the exocytose modulation. LEV have, already, shown efficacy as adjunctive therapy in focal epilepsies with and without secondary generalisation. Recent reports seem to suggest its efficacy on idiopathic generalized epilepsy (IGE). Our study reports the efficacy and tolerability of LEV monotherapy in IGE in an unselected group of adolescents who attended our epilepsy services between Jan 2002-Dec 2003.

Methods: We have followed-up 11 patients (4M and 7F), with a mean age 14.9 affected by IGE. Four patients had IGE with grand mal seizures on awakening and 3 of these were photosensitive. Seven patients had juvenile myoclonic epilepsy (JME), all of them photosensitive. Therapeutic dose was between 1000 and 1500mg/day. During every follow-up visit, ranged between 12–22 months, we administered a questionnaire about side effects to evaluate tolerability to LEV.

Results: At the last observation all patients were seizure-free, and a complete abatement of photoparoxysmal EEG response was achieved in patients with photosensitivity. In a single patient a significant, although transient somnolence was reported, which required slowing of the titration.

Conclusion: Our experience seems to suggest that Levetiracetam can be extremely effective and well tolerated as monotherapy in patients with generalized seizures. Our encouraging results, if confirmed by blinded studies using appropriate randomisation, suggest that Levetiracetam has the potential to be considered as first-line treatment particularly in adolescent females with JME, given the well-known potentially teratogenic effect of sodium valproate.