Arzu EKİCİ, Sevgi YİMENİCİOĞLU, Havva KAYA

Epilepsili Çocuklarda Levetirasetam Monoterapisi Etkili Ve Güvenli midir?

Giriş: Geniş spektrumlu ve geniş güvenlik marjına sahip ikinci nesil bir antiepileptik ilaç olan levetirasetam, hem fokal hem de jeneralize nöbet tedavisinde kullanılmaktadır. Bu çalışmada epilepsili çocuklarda levetirasetam monoterapisinin etkinliğini, yan etkilerini ve güvenliğini belirlemeye karar verdik.Yöntemler: Levetirasetam monoterapisi ile tedavi edilen ardışık 102 hastanın tıbbi kayıtları geriye dönük olarak değerlendirildi.Bulgular: Levetirasetam monoterapisi alan 50 (%49) kız ve 52 (%51) erkek toplam 102 hasta değerlendirildi. Hastaların ortanca yaşı 121,5 (62,25-178.5) aydır. Hastaların çoğunluğu (%95.1) jeneralize epilepsi hastasıydı. Yirmi yedi (%26,5) hastada eşlik eden nörolojik problemler vardı. Levetirasetam dozu 20-80 mg/kg/gün idi. Yirmi sekiz (%27.5) hastada yan etkiler görüldü. En sık görülen yan etkiler sinirlilik (%10.8) ve enürezis nokturna (%3.9) idi. Sinirlilik (%4.9), enürezis nokturna (%1) ve baş ağrısı (%1) bırakma nedeniydi. Tedavi öncesi anormal EEG'nin 24'ü (%51.1) düzeldi ve levetirasetam tedavisi sonrası hastaların 74'ü (%72.5) nöbetsiz kaldı. Levetirasetam tedavisi öncesi ve sonrası EEG anormalliği arasında istatistiksel olarak anlamlı fark vardı (p=0,001). 10'dan fazla (%9.8) hastanın tamamı, tedavinin 12. ayında yan etkiler (n:7, %6.9) ve etkisizlik (n:3, %3) nedeniyle tedaviyi bırakmıştır. Elde tutma oranı %90.2 idi.Sonuç: Bu çalışma, levetirasetam monoterapisinin yüksek oranda nöbet azaltma, düşük ciddi yan etkiler ve etkisizlik oranları, çocuklarda tedavi öncesi EEG iyileşmesi üzerinde anlamlı fark olduğunu göstermektedir.

Anahtar Kelimeler:

advers reaksiyon, çocuklar, etkinlik, epilepsi, levetirasetam, monoterapi

Is Levetiracetam Monotherapy Effective And Safe In Children With Epilepsy?

Introduction: Levetiracetam a second-generation antiepileptic drug with a broad spectrum and a wide safety margin, is used in both focal and generalized seizure treatment. In this study, we decided determine efficacy, side effects and safety of levetiracetam monotherapy in children with epilepsy.Methods: The medical records of consecutive 102 patients who were treated with levetiracetam monotherapy were evaluated retrospectively.Results: Total of 102 patients on levetiracetam monotherapy, 50 (49%) girls and 52 (51%) boys, were evaluated. Median age of the patients is 121.5 (62.25-178.5) months. Majority of the patients (95.1%) had generalized epilepsy. Twenty-seven (26.5%) patients had concomitant neurological problems. Dosing of levetiracetam was 20-80 mg/kg/day. Twenty eight (27.5%) patients had adverse reactions. The most common side effects were nervousness (10.8%) and enuresis nocturna (3.9%). Nervousness (4.9%), enuresis nocturna (1%) and headache (1%) were the reason for discontinuation. Twenty four (51.1%) of abnormal pre-treatment EEG had recovered and 74 (72.5%) of patients were seizure free after levetiracetam treatment. There was a statistically significant difference between levetiracetam treatment pre- and post-EEG abnormality (p=0.001). All over 10 (9.8%) patients were discontinued the treatment due to adverse effects (n:7, 6.9%) and inefficacy (n:3, 3%) at the 12 month of the treatment. The retention rate was 90.2%.Conclusion: This study suggests that levetiracetam monotherapy had high percentage of seizure reduction, low rates of serious adverse events and inefficacy, significant difference on pre-treatment EEG recovery in children.

Keywords:

adverse reaction, children, efficacy, epilepsy, levetiracetam, monotherapy,

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