Efficacy and tolerability of levetiracetam in children younger than 4 years: A retrospective review

Purpose: To review our experience of the efficacy and tolerability of levetiracetam (LEV) in children younger than 4 years. Methods: We used retrospective chart review to identify 122 children with seizures who were younger than 4 years and followed for >= 6 months. Efficacy was evaluated on the basis of the occurrence and durability of seizure remission. Tolerability was based on parent- and patient-reported side effects. Results: Seventy (57%) subjects achieved seizure remission, and 52 (43%) did not. In univariate analysis, those achieving seizure remission were more likely to have partial epilepsy, require lower maintenance doses of LEV, and have fewer than two seizures per month at initiation of the medication. Only seizure frequency at initiation of LEV remained significant in multivariate analysis. The median duration of seizure freedom (8.9 months) was not influenced by age, epilepsy type, gender, or pretreatment seizure frequency. The dose of LEV was the only significant predictor of the duration of seizure remission, with longer duration of seizure remission seen in those taking < 30 mg/kg/day compared with those taking > 30 mg/kg/d (median, 12.8 months vs. 3 months; p < 0.0001). Side effects of LEV occurred in 34% of subjects but required discontinuation in only 16%, most commonly because of behavioral disturbances. Conclusions: LEV is an effective medication in children younger than 4 years and at doses lower than previously reported. It is also well tolerated, suggesting that it represents an important option for the treatment of epilepsy in this age group.