Acute Effect of Levetiracetam on Interictal Epileptiform Discharges in Persons with Idiopathic Generalized Epilepsy (P2.086)

OBJECTIVE: The study objective is to retrospectively assess the acute effect of levetiracetam (LEV) on interictal epileptiform discharges (IEDs) in persons with idiopathic generalized epilepsy (IGE). BACKGROUND: Several investigators have reported that LEV reduces IEDs in persons with IGE on serial recordings measured over days to months. One study demonstrated an acute effect of LEV on the photo-paroxysmal response. The rapid oral absorption of LEV may offer the ability to quickly assess this effect in persons with frequent IEDs. METHODS: We retrospectively identified 5 LEV-naive patients with IGE who received their first dose during an EEG study. Pre-LEV analysis was performed during the hour immediately preceding LEV administration and a one hour Post-LEV analysis started one hour after oral dosing or following administration of a parenteral infusion. EEGs were analyzed for total number of IEDs, maximum IED burst duration and spike-wave index (SWI, the number of seconds with IEDs divided by total EEG duration). RESULTS: In 3 patients the principle seizure type was generalized tonic-clonic seizures, 1 juvenile myoclonic epilepsy with frequent myoclonias and 1 absence seizures. All patients received LEV 1000 mg - 3 orally and 2 parenterally. Pre-LEV IED counts were 93, 178, 40, 229 and 2, respectively. Post-LEV counts dropped to 0, 76, 3, 9, and 0, respectively. Maximum burst durations went from a range of 0.3-10 s Pre-LEV to 0-2.5 s Post-LEV and the SWI from 0.5-12.8[percnt] to 0-4.1[percnt]. CONCLUSIONS: This series is the first to report that LEV acutely reduces IEDs in persons with IGE. We show a decrease in IEDs within two hours of administration. In persons with frequent IEDs an assessment of this LEV effect is feasible during a three hour EEG recording. Disclosure: Dr. Jarvis has nothing to disclose. Dr. Spaulding has nothing to disclose. Dr. McSherry has nothing to disclose. Dr. Nagle has nothing to disclose.