Experience of Intravenous Levetiracetam in Acute Repetitive Seizures in Children: Case Series from a Single Tertiary Center

Background: Intravenous levetiracetam (LEV) has been reported to be well tolerated and effective in treating status epilepticus and acute repetitive seizures in children. Compared with traditional anticonvulsants, LEV has fewer cardiopulmonary depression and sedative effects. We describe four patients belonging to two epileptic syndromes who were refractory to standard treatment protocols and whose seizures were well controlled by intravenous LEV administration. Method: This was a retrospective chart review of in patients who received intravenous LEV as adjunctive therapy to treat acute repeated seizures from January 2013 to December 2013. Information was collected based on age/gender, underlying disease, concomitant anticonvulsants, major seizure types, seizure frequency before and after intravenous LEV treatment, the dose and the duration of LEV usage, and short-term adverse effects during and after infusion. The paired t test was used to compare seizure frequencies before and after intravenous LEV. Results: Four patients (mean age 6.3 ± 5.53 years) who received intravenous LEV had acute repetitive seizures, and were clinically diagnosed as intractable epilepsy. Two patients had acute encephalitis with refractory repetitive partial seizures (AERRPS) and the other two patients had infantile spasms (IS). Their seizures were controlled by three or more oral antiepileptic agents. The mean loading dose of LEV was 17.9 mg/kg/dose (range 11.6 to 22.7 mg/kg/dose), and the mean duration of LEV usage was 6.5 days (4 to 11 days). The seizure frequency before intravenous LEV treatment was 9.25 fits per day (5-20 fits per day), which decreased after intravenous LEV treatment to 2.7 fits per day (1-8 fits per day). All of the four patients had favorable responses in seizure frequency reduction after the administration of intravenous LEV. None of the patients reported any side effects after LEV treatment, and all four patients received LEV as oral adjunctive therapy after discharge. Conclusions: Our results suggest that intravenous LEV can successfully reduce the frequency of seizures in patients with epilepsy syndromes leading to refractory epilepsy. Physicians commonly face the dilemma of controlling seizures and cardiopulmonary depression due to anticonvulsant therapy. Intravenous LEV was well tolerated without any side effects in all of our patients, and therefore we suggest that intravenous LEV should be considered to control repetitive clustering seizures before the use of other traditional intravenous anticonvulsants due to the high efficacy and scanty side effects. However, further studies with a larger number of patients are needed to confirm our findings.