A retrospective study of the efficacy and tolerability of Levetiracetam (Keppra) as a first line monotherapy in childhood epilepsy

Background Levetiracetam is an anticonvulsant licensed as monotherapy in those over 16 years and as add-on therapy in childhood epilepsy since 2005. Off-label use of Levetiracetam has increased considerably over the last... [ view full abstract ]

Background
Levetiracetam is an anticonvulsant licensed as monotherapy in those over 16 years and as add-on therapy in childhood epilepsy since 2005. Off-label use of Levetiracetam has increased considerably over the last decade. There are 4 retrospective studies of Levetiracetam monotherapy use in children naive to anticonvulsants, involving 155 children and documenting seizure freedom in more than 60%.

Aims and objectives
We aim to report our experience in a national cohort of children prescribed Levetiracetam monotherapy as first line agent over a 5-year period, outlining treatment success (seizure freedom or >50% reduction in seizure frequency) at one year and treatment failure (<50% reduction in seizure frequency) or discontinuation of Levetiracetam because of side effects.

Methods
We undertook a retrospective analysis of children’s medical records attending 4 tertiary Paediatric Neurology Clinics between January 2009 and December 2014. Inclusion criteria are children aged 3 months–16 years, with a diagnosis of epilepsy, prescribed Levetiracetam as a first line monotherapy for their epilepsy. The findings reported on in this abstract relate to children from the first data collection site (n=52 children) and were analysed descriptively. Ethical approval was obtain from relevant hospital sites.

Findings:
Findings on 52 children from one centre (age mean 7.5 years (SD 5.4)) demonstrate that 46% recorded a >50% improvement or seizure freedom at 1 year. 37% of all patients reported experiencing at least one adverse effect (low mood and irritability most commonly). The drug was discontinued in 40% of cases; lack of efficacy (12%), side effects (19%), no longer required (9%).

Conclusion and implications:
Levetiracetam in monotherapy is an effective and safe anticonvulsant for children with focal and generalised epilepsy aged 3 months-16 years. However, side-effects limit tolerance of the drug in nearly a fifth of patients. This is an important consideration for clinicians when managing patient care.