A Cochrane review [Abstract] 1 included 9 studies with a total of 1565 patients. They had drug-resistant focal epilepsy with seizures despite of at least one concomitant antiepileptic drug. The levetiracetam dose was 1000-4000 mg/day, the treatment ranged from 12 to 24 weeks. For the 50% or greater reduction in focal seizure frequency, RR was significantly in favour of levetiracetam at all doses. The naive estimates, ignoring dose, showed that 39% of adults were responders. NNT for an additional beneficial outcome was 5 (95% CI 4-6). When results for the two trials using levetiracetam 2000 mg were combined (n=312), RR for 50% or greater reduction in focal seizure frequency was 4.91 (95% CI 2.75-8.77), with an RR of 0.68 (95% CI 0.60-0.77) for non-response. At this dose, 37% of adults were responders. Patients were not more likely to have levetiracetam withdrawn (RR 0.98; 95% CI 0.73-1.32). Somnolence (RR 1.51; 99% CI 1.06-2.17) and infections (RR 1.76; 99% CI 1.03-3.02) were significantly associated with levetiracetam, whereas accidental injury was significantly associated with placebo (RR 0.60; 99% CI 0.39-0.92). Changes in behaviour were negligible (1% affected; RR 1.79; 99% CI 0.59-5.41). Levetiracetam had a positive effect on cognition and some aspects of QoL.
Comment: The quality of evidence is downgraded by study quality (short follow-up time).
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