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Levetiracetam in der Kombinationsbehandlung fokaler Epilepsien

Erfahrungen bei 80 Patienten

Levetiracetam in combined therapy for focal epilepsy: experience with 80 patients

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Zusammenfassung

Hintergrund

Levetiracetam wurde im Jahre 2000 in Deutschland als Antikonvulsivum zur Zusatztherapie fokaler Epilepsien zugelassen. Die Effektivität und Verträglichkeit wird in der vorliegenden retrospektiven Analyse untersucht.

Methoden

Bei 80 konsekutiv mit Levetiracetam add-on behandelten Patienten mit fokalen Epilepsien wurde der Effekt von Levetiracetam auf die Anfallsfrequenz sowie die Inzidenz von Nebenwirkungen untersucht.

Ergebnisse

Bei einem mittleren Follow-up-Zeitraum von 12,3 Monaten wurde bei 18,8% der mit Levetiracetam behandelten Patienten Anfallsfreiheit erzielt, bei 15,0% eine Anfallsreduktion um mindestens 75% und bei weiteren 3,8% um mindestens 50%. Eine Dosissteigerung über 3500 mg/Tag hinaus führte nicht zu einer Steigerung der Effektivität, ging jedoch mit einem erhöhten Risiko paradoxer Effekte auf die Anfallsfrequenz und psychischer Nebenwirkungen einher. Levetiracetam war wirksam gegen alle Anfallstypen und unabhängig von der Fokuslokalisation. Ein Wirkverlust bei längerer Behandlungsdauer war selten. Häufigste unerwünschte Effekte der Therapie stellten Somnolenz und Aggressivität dar; eine rasche Eindosierung beeinträchtigte die Verträglichkeit nicht.

Schlussfolgerung

Levetiracetam stellt ein potentes, gut handhabbares und überwiegend gut verträgliches Antikonvulsivum dar, mit dem auch auch bei schwierig therapierbaren Patienten mit fokalen Epilepsien eine deutliche Anfallsreduktion oder Anfallsfreiheit erzielt werden können.

Abstract

Background

Levetiracetam was released in 2000 as an antiepileptic drug for add-on treatment of focal epilepsies. Its efficacy and tolerability were investigated in this retrospective study.

Methods

The effects of add-on treatment with levetiracetam on seizure frequency and side effects were analyzed retrospectively in 80 consecutive patients with focal epilepsy.

Results

With a mean follow-up of 12.3 months, 18.8% of patients treated with levetiracetam became seizure-free, and additional 15.0% and 3.8% had reductions in seizure frequency of 75% and 50%, respectively. Increasing the dosage to more than 3,500 mg/day did not improve efficacy but could induce a paradoxical increase in seizure frequency and psychic side effects. Levetiracetam was efficacious against all seizure types independently of focus localization. There was no evidence for the development of tolerance with longer periods of treatment. The most common adverse effects were somnolence and aggressiveness; tolerability did not decrease with rapid titration.

Conclusions

Levetiracetam is a potent and generally well tolerable new antiepileptic drug which is also efficacious in patients with difficult-to-treat focal epilepsies.

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Authors and Affiliations

  1. Epilepsiezentrum, Universitätsklinikum Freiburg, Freiburg, Deutschland

    Andreas Schulze-Bonhage, B. Feil, S. Fauser & V. Homberg

  2. Epilepsiezentrum, Neurozentrum des Universitätsklinikums Freiburg, Breisacher Straße 64, 79106, Freiburg, Deutschland

    Andreas Schulze-Bonhage

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  1. Andreas Schulze-Bonhage
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  2. B. Feil
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  3. S. Fauser
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  4. V. Homberg
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Correspondence to Andreas Schulze-Bonhage.

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Schulze-Bonhage, A., Feil, B., Fauser, S. et al. Levetiracetam in der Kombinationsbehandlung fokaler Epilepsien. Nervenarzt 75, 749–754 (2004). https://doi.org/10.1007/s00115-004-1696-5

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