Levetiracetam may be more effective for late-onset partial epilepsy.

BACKGROUND Many agents are available for treating epilepsy; however, population studies have failed to show overall differences in efficacy for a given seizure type. Clinical experience suggests that certain individuals will respond to a given agent while others with the same seizure type will not. OBJECTIVES To examine a population of patients who received one of the newer antiepileptic drugs, levetiracetam, and to identify those who had either a dramatic improvement or a significant worsening of seizures. METHODS Retrospective medical record review of patients with refractory epilepsy. RESULTS Patients who responded well to levetiracetam therapy were older at the onset of epileptic seizure than those who did not (mean [SD] age, 51 [5] vs 27 [3] years; P<.05). This was also true of the subset of patients who had localization-related epilepsy. Patients with temporal lobe onset were likely to do well whereas patients with frontal lobe onset were not. CONCLUSIONS These results suggest that certain subpopulations may be particularly likely to respond to levetiracetam therapy. These need to be confirmed in a larger prospective trial; however, looking for specific characteristics of patients who respond to certain drugs may lead to useful guidelines for drug choices in treating epilepsy.

[1]  C. McNew,et al.  Effect of divalproex-lamotrigine combination therapy in frontal lobe seizures. , 2001, Archives of neurology.

[2]  M. Sammaritano,et al.  Distribution of partial seizures during the sleep–wake cycle , 2001, Neurology.

[3]  P. Genton,et al.  Antimyoclonic effect of levetiracetam. , 2000, Epileptic disorders : international epilepsy journal with videotape.

[4]  K. Malmgren,et al.  Gabapentin Versus Vigabatrin as First Add‐On for Patients with Partial Seizures That Failed to Respond to Monotherapy: A Randomized, Double‐Blind, Dose Titration Study , 2000, Epilepsia.

[5]  Simon Shorvon,et al.  Multicenter Double‐Blind, Randomized, Placebo‐Controlled Trial of Levetiracetam as Add‐On Therapy in Patients with Refractory Partial Seizures , 2000 .

[6]  F. Dreifuss,et al.  Levetiracetam for partial seizures , 2000, Neurology.

[7]  A. Beydoun,et al.  Oxcarbazepine monotherapy for partial-onset seizures , 2000, Neurology.

[8]  M. Park,et al.  Lamotrigine Monotherapy in Newly Diagnosed Untreated Epilepsy: A Double‐Blind Comparison with Phenytoin , 1999, Epilepsia.

[9]  R. Fisher,et al.  Oxcarbazepine: double-blind, randomized, placebo-control, monotherapy trial for partial seizures. , 1999, Neurology.

[10]  B. Steinhoff,et al.  Nonconvulsive Status Epilepticus in Two Patients Receiving Tiagabine Treatment , 1998, Epilepsia.

[11]  S. Kochen,et al.  A double-blind controlled clinical trial of oxcarbazepine versus phenytoin in adults with previously untreated epilepsy 1 This study was carried out on behalf of the International Adult Oxcarbazepine/Phenytoin Trial Group (see Appendix A). 1 , 1997, Epilepsy Research.

[12]  N. Fejerman,et al.  A double-blind controlled clinical trial of oxcarbazepine versus phenytoin in children and adolescents with epilepsy 1 This work was carried out on behalf of the International Pediatric Oxcarbazepine/Phenytoin Trial Group (Appendix A). 1 , 1997, Epilepsy Research.

[13]  B. Steinhoff,et al.  A double-blind controlled clinical trial: oxcarbazepine versus sodium valproate in adults with newly diagnosed epilepsy 1 This work was carried out on behalf of the International Oxcarbazepine/Valproate Trial Group (see Appendix A). 1 , 1997, Epilepsy Research.

[14]  G. Pledger,et al.  Double‐Blind, Placebo‐Controlled Trial of Topiramate (600 mg Daily) for the Treatment of Refractory Partial Epilepsy , 1996, Epilepsia.

[15]  G. Pledger,et al.  Topiramate placebo-controlled dose-ranging trial in refractory partial epilepsy using 200-, 400-, and 600-mg daily dosages , 1996, Neurology.

[16]  G. Pledger,et al.  Topiramate placebo-controlled dose-ranging trial in refractory partial epilepsy using 600-, 800-, and 1,000-mg daily dosages , 1996, Neurology.

[17]  M. Brodie,et al.  Double-blind comparison of lamotrigine and carbamazepine in newly diagnosed epilepsy , 1995, The Lancet.

[18]  T. Halonen,et al.  Comparison of oxcarbazepine and carbamazepine: a double-blind study , 1987, Epilepsy Research.

[19]  J. Cramer,et al.  Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures. , 1985, The New England journal of medicine.

[20]  C L Rümke,et al.  [Incidence and prevalence]. , 1983, Nederlands tijdschrift voor geneeskunde.