Levetiracetam for the treatment of idiopathic generalized epilepsy with myoclonic seizures.

BACKGROUND: Currently, there are no published randomized controlled trials evaluating the efficacy and safety of adjunctive antiepileptic therapy in idiopathic generalized epilepsy with myoclonic seizures. METHODS: This randomized, double-blind, placebo-controlled multicenter trial assessed the efficacy and tolerability of adjunctive treatment with levetiracetam 3,000 mg/day in adolescents (>or=12 years) and adults (or=8 days during a prospective 8-week baseline period, despite antiepileptic monotherapy. The 8-week baseline period was followed by 4-week up-titration, 12-week evaluation, and 6-week down-titration/conversion periods. RESULTS: Of 122 patients randomized, 120 (levetiracetam, n = 60; placebo, n = 60) were evaluable. Diagnoses were either juvenile myoclonic epilepsy (93.4%) or juvenile absence epilepsy (6.6%). A reduction of >or=50% in the number of days/week with myoclonic seizures was seen in 58.3% of patients in the levetiracetam group and in 23.3% of patients in the placebo group (p < 0.001) during the treatment period. Levetiracetam-treated patients were more likely to respond to treatment than patients receiving placebo (OR = 4.77; 95% CI, 2.12 to 10.77; p < 0.001). Levetiracetam-treated patients had higher freedom from myoclonic seizures (25.0% vs 5.0%; p = 0.004) and all seizure types (21.7% vs 1.7%; p < 0.001) during the evaluation period. The only adverse events more frequent with levetiracetam were somnolence and neck pain. CONCLUSION: These results suggest that levetiracetam is an effective and well-tolerated adjunctive treatment for patients with previously uncontrolled idiopathic generalized epilepsy with myoclonic seizures.

Frontal intermittent rhythmical delta activity and anterior bradyrhythmia.

Rhythmical intermittent delta activity was found in 162 patients (out of a total of 5,542 patients; i.e. 2.9%). The typical features of frontal rhythmical intermittent delta activity (FIRDA) were noted in 105 patients while in 43 the pattern of anterior bradyrhythmia (AB) was present. Mental decline with delirium or dementia was the most common clinical correlate in cases of FIRDA, whereas cerebrovascular disorder represented the by far most frequent etiology in cases of AB. The patient group with AB proved to be older than the population with FIRDA. Stress was laid on the distinctive EEG features of FIRDA and AB as well as their relationship to the level of vigilance. FIRDA invariably showed a maximum over the frontopolar region whereas AB was maximally developed either over frontopolar or over superior frontal areas. There is reason to presume that a superior frontal maximum is related to arousal mechanisms (with input into the supplementary motor zone). On the other hand, it is hypothesized that the frontopolar maximum of FIRDA reflects thought processes in a frontal lobe with compromised circulation.