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Safe use of levetiracetam at doses higher than the maximum recommended (Abstract number: 4CPS-175) (ATC code: N03 -Antiepileptics) Contact email: [email protected] C. Mariño Fernández1, R. Juvany Roig1, C. Esteban Sánchez1, M. Falip Centellas2, R. Rigo Bonnin3, J. Sala Padró2, R. Jodar Masanes1 1 Hospital Universitari Bellvitge- IDIBELL, Pharmacy, Hospitalet de Llobregat, Spain. 2 Hospital Universitari Bellvitge- IDIBELL, Neurology (Epilepsy Unit), Hospitalet de Llobregat, Spain. 3 Hospital Universitari Bellvitge- IDIBELL, Clinical Laboratory, Hospitalet de Llobregat, Spain. Objective To describe the importance of therapeutic drug monitoring (TDM) of levetiracetam (LEV) for minimizing toxicity when it is used at doses higher than recommended (maximum 3000mg/ day according to the summary product). Methods Case report of 57 year-old man diagnosed with symptomatic focal epilepsy and human immunodeficiency virus. Antiepileptic treatment: LEV 4000 mg/ day, topiramate 300 mg/ day and clonazepam 4 mg/ day since 2010 plus lacosamide 200 mg/ day added in 2015. In September 2016 dosage of LEV was increased to 4500mg/ day because he had a new neurological crisis. Antiretroviral medication (AM): was changed in 2013 from tenofovir/efavirenz/emtricitabine to abacavir/ lamivudine plus efavirenz. In January 2017 AM medication was simplified to dolutegravir/abacavir/ lamivudine. Results and discussion Dose GFR Cmin LEV Toxicity Date Comments (mg/day) (ml/min/1.73 m2) (μg/ mL) signs November 2015 4000 >60 --- No --- This was the situation after six years with LEV 4000mg/ day 2 April 2016 4000 >60 35.9 No and glomerular filtration rate (GFR) >60 ml/min/1.73 m . The LEV therapeutic range is [10-40 μg/ mL]. Yes Three months after increasing the dose of LEV, there were March 2017 4500 51 67.1 tired and high levels of LEV and a slight deterioration of renal function. sleepy Concomitant medication seemed not interact with LEV. After reducing the dose of LEV, values returned to the June 2017 3500 50 36.3 No normality and clinical signs of toxicity disappeared. Conclusions LEV at doses higher than recommended could be used safely if there is a close TDM program to assure treatment effectiveness and minimize adverse effects. .

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STATUS EPILEPTICUS in ADULTS (Convulsive Seizures in Patients Aged > 16 Years Old) Link Consultant: Dr Hannah Cock
STATUS EPILEPTICUS IN ADULTS (Convulsive Seizures in patients aged > 16 years old) Link consultant: Dr Hannah Cock Status epilepticus (SE) is defined as continuous seizure activity which has failed to self- terminate leading to a risk of neurological damage. The risks are highest with generalised tonic/clonic (convulsive) seizures. Convulsive SE may present as either a run of discreet generalised tonic/clonic seizures without full recovery in between (ie without regaining consciousness), or continuous generalised tonic/clonic seizure activity. Most convulsive seizures terminate spontaneously within 3 minutes, and do NOT need emergency treatment. Convulsive seizures lasting longer than 5 minutes, or recurring without recovery should be managed as Convulsive SE, unless the patient is known to habitually have longer seizures with self-termination (eg information from relatives, friends, or the patient’s epilepsy card or diary). The mortality and morbidity of generalised status epilepticus is high, and it is important to control fits as soon as possible, to use adequate doses of 1st and 2nd line agents, but not to over-treat patients in whom seizures have terminated but are slow to recover. GENERAL MANAGEMENT 1st stage (0-10mins). Protect the patient e.g. padded bed rails. Do not restrain. Administer oxygen. During an inter-ictal period insert an airway and then administer oxygen. Do not attempt to insert anything in the patient’s mouth during a seizure, even if the tongue is injured. Place the patient in a semi-prone position with the head down to prevent aspiration. Establish iv access. Note the time. 2nd Stage (0-30mins). Institute regular monitoring (temperature, cardiac, respiration, BP).
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Restless Legs Syndrome in Patients with Epilepsy Under Levetiracetam Monotherapy
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