Nolan Danielle, Lester Shannon G, Rau Stephanie M, Shellhaas Reneé A
1 Division of Epilepsy, Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
2 Division of Pediatric Neurology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
J Child Neurol. 2019 Feb;34(2):94-98. doi: 10.1177/0883073818811511. Epub 2018 Nov 21.
Levetiracetam is prescribed for a broad spectrum of seizure types but does not have a specific indication for absence epilepsy. We hypothesized that levetiracetam is commonly prescribed for children with absence epilepsies and evaluated the efficacy of this medication for absence epilepsy treatment in clinical practice. We also hypothesized that electroencephalographic (EEG) findings could help predict levetiracetam efficacy.
We reviewed the charts of all patients treated for new-onset absence epilepsies at our pediatric neurology clinic between January 2011 and January 2016. Among 158 children diagnosed with absence epilepsies, 72 were treated with levetiracetam.
Levetiracetam was discontinued in 74% (n = 53/72) because of incomplete seizure control (59%, n = 35/72) and/or intolerable side effects (41%, n = 24/72) after a median 8.5 months (interquartile range 2, 17 months). Among patients for whom levetiracetam was effective, 44% (n = 8/18) had polyspikes on their initial EEG, versus 27% (n = 14/52) of patients for whom levetiracetam was discontinued ( P = .17). The maximal prescribed dose was lower for children in whom levetiracetam was effective (29 ± 13 mg/kg/d) than those for whom levetiracetam failed (42 ± 20 mg/kg/d; P = .005).
In routine clinical practice, levetiracetam is often chosen for patients with absence seizures. However, only about one-quarter of children with absence epilepsy in this study became seizure free with levetiracetam. When effective, levetiracetam can control absence epilepsy at a relatively low dose. Lack of seizure control requiring continued dose escalation should prompt early consideration of a therapeutic medication transition.
左乙拉西坦被用于治疗多种类型的癫痫发作，但对失神癫痫并无特定适应症。我们推测左乙拉西坦常用于治疗失神癫痫患儿，并评估了该药物在临床实践中治疗失神癫痫的疗效。我们还推测脑电图（EEG）结果有助于预测左乙拉西坦的疗效。
我们回顾了2011年1月至2016年1月在我们儿科神经科诊所接受新发失神癫痫治疗的所有患者的病历。在158名被诊断为失神癫痫的儿童中，72名接受了左乙拉西坦治疗。
由于癫痫发作控制不完全（59%，n = 35/72）和/或无法耐受的副作用（41%，n = 24/72），左乙拉西坦在中位8.5个月（四分位间距2, 17个月）后被停用，停用率为74%（n = 53/72）。在左乙拉西坦有效的患者中，44%（n = 8/18）在初始脑电图上有多棘波，而在左乙拉西坦停药的患者中这一比例为27%（n = 14/52）（P = 0.17）。左乙拉西坦有效的儿童的最大处方剂量（29±13mg/kg/d）低于左乙拉西坦治疗失败的儿童（42±20mg/kg/d；P = 0.005）。
在常规临床实践中，左乙拉西坦常被用于失神发作患者。然而，在本研究中，只有约四分之一的失神癫痫儿童使用左乙拉西坦后癫痫发作得到控制。当有效时，左乙拉西坦可以用相对较低的剂量控制失神癫痫。缺乏癫痫发作控制需要持续增加剂量应促使尽早考虑更换治疗药物。
