Clinical experience with intravenous levetiracetam in 48 pediatric patients for the management of acute seizures and uncontrolled epilepsy

INTRODUCTION: In the treatment of epilepsy it is necessary to select drugs with high efficacy and minimum side effects. Levetiracetam seems to have an ideal pharmacological profile. Although the oral route is the usual form of administration, sometimes it is required the intravenous administration. OBJECTIVE: To describe the clinical profile, indications in intravenous administration and seizures control of 48 pediatric epileptic patients managed with intravenous levetiracetam in monotherapy or add-on therapy. METHODS: This is a retrospective and observational study performed at the National Institute of Pediatrics between February 2011 to April 2013, in patients receiving intravenous levetiracetam, for whom the enteral route was contraindicated. RESULTS: A total of 48 records were included, 60% of the population < 2 years. Symptomatic focal epilepsy was present in 39 patients (81%). The most common etiologies were: hypoxic-ischemic encephalopathy (HIE) (n = 14), cerebral dysgenesis (n = 10) and acquired metabolic disorders (n = 7). Indications for intravenous administration: uncontrolled seizures (n = 23) and fasting due to medical illness (n = 11). A total of 43 patients (89.5%) were seizure-free during the first 24 h. Intravenous administration was performed with dose 20 mg/kg b.i.d. and the patients received 2 to 6 IV doses, without any adverse effects. Once the enteral route was restored, the change from intravenous to oral route was made in equivalent doses. In all, 35 patients (73%) maintained levetiracetam treatment in mono/politherapy for up to 36 months (average 18.5 months, SD +/- 10.5). A total of 13 patients (27%) discontinued levetiracetam, none for therapeutic failure, 1 patient developed aggression during the first week as adverse event and suspended levetiracetam, followed by economic hardship. CONCLUSIONS: This series shows that levetiracetam is an antiepileptic drug that enabled adequate control in acute seizures and chronic management of epilepsy. Adherence was obtained in 80% of patients. The levetiracetam is a safe, broad-spectrum antiepileptic with few adverse effects and is a good option for intravenous use in children.