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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 answered clinically and electrographically to LEV. Methods: We evaluated with continuous video / electroencephalography an adult with generalized onset seizures 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. Re Lts: 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 mg, 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 with 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.