Efficacy of levetiracetam as first add-on therapy to carbamazepine and valproate sodium for children with epilepsy

We examined the effectiveness of levetiracetam (LEV) as add-on therapy after failed treatment with a first anti-epileptic drug in a prospective cohort of children with epilepsy. Eligible patients with epilepsy experienced uncontrolled seizures with the first anti-epileptic drug and were 1-15-year-old. After a 3 mo baseline period, patients were administered LEV at an initial dose of 10 mg/kg/d, which, if needed, was incrementally increased by 5 mg/kg/d weekly up to a maximum dose of 60 mg/kg/d. Seizure frequency was defined as the mean seizure frequency per month. Clinical response to LEV over the following period of at least 6 mo was divided into five categories. A total of 37 patients were enrolled. The majority of patients (97.30%) had localization-related epilepsy. The responder rate (rate of patients with >= 50% reduction in seizure frequency) was 30/37 (81.08%). In addition, 20 of 37 (54.05%) patients showed complete seizure cessation. Mean percentage reduction in seizure frequency (all types of seizures) during the first 6 mo treatment period compared to baseline was 89.28% in responders, compared with 25.22% in non-responders. This proportion remained stable during the second 6 mo period (90.17%). Significant changes in seizure frequency were seen between before LEV administration and both the first 6 mo (P < 0.01) and second 6 mo (P < 0.01) in responders, but not in non-responders. Mean effective dose of LEV was 27.51 mg/kg/d. Somnolence was the only reported individual adverse event (5.41%), and was mild in all cases, so LEV discontinuation was not needed. LEV appears useful as a first add-on treatment in children with localization-related epilepsy.