Faculty Bibliography

The current evidence-based data on efficacy, safety, and administration of the 7 new antiepileptic drugs (AEDs) approved over the past 10 years by the US Food and Drug Administration to treat new-onset and refractory epilepsy in children and adults is summarized based on the recent American Academy of Neurology (AAN) guidelines. The clinical trial work still necessary as well as areas where such research would not be informative and those in which nonevidence-based strategies are needed are highlighted in efforts to provide clinicians with the most up-to-date information on treatment regimens for patients with epilepsy. The limited amount of data currently available on these newer AEDs and the existence of traditionally efficacious medications complicate therapeutic decision-making for the clinician. Neurologists are encouraged to integrate the AAN guidelines with clinical experience, opinion, and other considerations of special populations until an exhaustive set of guidelines is available for a wide variety of seizure types

Levetiracetam (Keppra) was evaluated in a subset of patients aged >/=65 years (n=78) enrolled in a large (n=1030) open-label, phase IV trial (the KEEPER trial). A 4-week dose adjustment was followed by a 12-week evaluation period. An overall median reduction in partial seizures of 80.1% (n=65) was observed. Overall, 76.9% of patients were >/=50% responders, 56.9% were >/=75% responders, and 40.0% were 100% responders. Levetiracetam was well tolerated, with 42.3% of patients reporting one or more adverse events. A total of 15 patients (19.2%) experienced an adverse event that led to discontinuation. Somnolence (n=13,16.7%) and dizziness (n=7,9.0%) were the most commonly reported adverse events. Despite the limitations of the open-label study design, these data provide information regarding the use of levetiracetam as add-on therapy for the treatment of partial-onset seizures in patients >/=65 years of age, including those requiring concomitant medications