Study finds safe & effective seizure treatment for elderly patients with epilepsy

December 09, 2003

MIAMI, Fla. and BOSTON - University of Miami researchers have found that the anti-epileptic drug (AED) Keppra (levetiracetam) controlled seizures and was well tolerated by more than 70 percent of elderly patients with epilepsy evaluated in a new study. More than a third of the patients in the study age 60 and over became seizure free and 60 percent of them were taking Keppra alone. The results were presented today at the American Epilepsy Society annual meeting, being held this week in Boston.

"Treating elderly patients with epilepsy can be a challenge because they are more sensitive to drug side effects and typically take multiple medications, making the selection of an anti-epileptic therapy that much more difficult," said Eugene Ramsay M.D., director, International Center for Epilepsy, University of Miami School of Medicine and study investigator. "Our study analyzed several age groups, but found Keppra was well tolerated and even more effective in the oldest group analyzed - patients 60 years and older."

The rate of epilepsy occurring in the elderly is twice that of people under 65 years of age. Many cases are caused by common conditions such as stroke, heart attack and Alzheimer's disease. Treatment in this population can be complicated by the existence of multiple health conditions and medications. A recent national survey found that more than 90 percent of people age 65 or older--not living in hospitals or institutions -- used at least one medication per week, and more than 40 percent used five or more different medications every week.

Keppra is indicated for the adjunctive treatment of partial onset seizures in adults with epilepsy.

Study Design and Results

This retrospective chart review examined patients treated with Keppra at the International Center for Epilepsy at the University of Miami. The elderly subset previously discussed was part of a larger review that stratified outcomes by age: 0-19 years (Group 1, five patients), 20-39 years (Group 2, 105 patients), 40-59 years (Group 3, 102 patients) and 60+ years (Group 4, 28 patients), for a total of 240 patients.

Records were reviewed and evaluated for seizure response, reason for discontinuing treatment, adverse events, dose, plasma level and type of seizure being treated. Dosing ranged from 250 mg/day to 5,000 mg/day with the mean being 1,830 mg/day.

The elderly population, Group 4, had the highest response rates to Keppra treatment, with 47.6 percent of patients becoming seizure free. Of the ten seizure free patients, six were on monotherapy. In other age groups, seizure freedom was achieved in 15.8 percent of Group 2 (four patients on monotherapy) and 28.6 percent of Group 3 patients (three patients on monotherapy). In total, thirteen patients on monotherapy were seizure free.

Twenty percent of Group 1, 27.6 percent of Group 2, 31.4 percent of Group 3 and 25.0 percent of Group 4 patients discontinued use of levetiracetam during the review period. Commonly reported side effects cited as reasons for stopping levetiracetam therapy were increased seizures, behavioral changes, bad feeling, pedal edema or swelling of the feet, pregnancy, skin rash, shakiness, sedation and increased salivation. There were no reported differences in incidence of side effects between age groups.
Editor's Note: study investigator is available for interviews.

American Epilepsy Society

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