ABSTRACT
This study reviews our experience with the safety and tolerability of levetiracetam (LVM) with different methods of intravenous administration in intensive care unit (ICU) patients. We used retrospective chart review to identify 33 ICU patients who received intravenous LVM for treatment of seizures. Collected data included age, gender, diagnosis on admission, dosing regimen, documented seizure activity, adverse reactions, concomitant use of other antiepileptic drugs, and condition on discharge. A total of 33 ICU patients were given intravenous (IV) LVM as add-on treatment to standard regimen for treatment of breakthrough seizures or status epilepticus or given as preventive medication postoperatively. Among these 33 patients, 16 received intravenous LVM as bolus, and 17 received intravenous LVM as continuous infusion. Safety and tolerability of intravenous LVM were evaluated on the basis of the occurrence of adverse or side effects reported in daily progress notes of the physicians and nurses. There were no significant adverse or side effects reported in daily progress notes. The addition of intravenous LVM to the standard regimen for controlling seizures in ICU patients seems feasible and tolerable.
Subject(s)
Anticonvulsants/administration & dosage , Intensive Care Units , Piracetam/analogs & derivatives , Status Epilepticus/drug therapy , Administration, Intravenous , Adult , Aged , Aged, 80 and over , Anticonvulsants/adverse effects , Anticonvulsants/therapeutic use , Female , Humans , Infusions, Intravenous/methods , Levetiracetam , Male , Middle Aged , Piracetam/administration & dosage , Piracetam/adverse effects , Piracetam/therapeutic use , Retrospective Studies , Seizures/drug therapy , Treatment Outcome , Young AdultABSTRACT
Special issues are related to AED testing in several populations. Pharmacokinetics, pharmacodynamics and underlying neurochemistry and developing systems require specific testing in appropriate infants with refractory seizures. EEG monitoring is an essential part of seizure definition and recognition, making it a necesssity along with clinical semiology to define the seizure types and changes in seizure frequency. (1) Neonates: A trial design for neonatal seizures should be similar to those used for the treatment of status epilepticus. Proposed study end points should be seizure cessation for some period of time, or time to next seizure. The use of placebo is questionable. (2) Partial seizures occurring in young infants: A trial designed for topirimate included a placebo controlled, double blind study with fixed dose trials exploring the range of tolerated doses. Forty-eight hour video EEGs were used for quantification of seizures. (3) Uncommon forms of encephalopathic epilepsy: a proposed design includes randomization to sequential monotherapy with prescribed titration/dose defined by seizure control or tolerance. Outcome variables include seizure reduction, tolerability, and time continued on AED.
