Successful treatment of atypical idiopathic focal epilepsy with CSWS with levetiracetam

Benign childhood epilepsy with centrotemporal spikes (BECTS) also known as benign rolandic epilepsy is the most frequent of all childhood epileptic syndrome. The debate about the differentiation of other (sub-)groups of idiopathic focal epilepsies is still going on. In 1982 Aicardi and Chevrie published their data on 32 patients with a less favourable course of the epilepsy and introduced the term atypical benign partial epilepsy of childhood. However, the term “benign“ in most instances seems not appropriate considering the outcome in many children. Some authors prefer the term atypical idiopathic partial epilepsy. In spite of the general benign course of BECTS children with atypical idiopathic focal epilepsy are characterized by different types of seizures occurring sometimes with high frequency. Unrelated to seizure frequency some children show an intense activation of EEG changes, sometimes with continuous spikes and waves during slow wave sleep (CSWS) with language dysfunction and/or neuropsychologic involvement. In theses cases, frequently many different antiepileptic drugs, often in combination, are used for seizure control with sometimes little or no success.

Levetiracetam (LEV) is a new anticonvulsant agent approved for patients older than 4 years in Germany. However, even though a few clinical trials have proven its usefulness in the treatment of childhood epilepsy, there are no clinical trials concerning the efficacy of LEV in specific epilepsy syndromes.

We describe the first case of idiopathic atypical focal epilepsy – resistant to therapeutic interventions with sulthiame, valproic acid, lamotrigine as well as steroid pulse therapy – with uncontrolled CSWS language dysfunction and neuropsychologic involvement successfully treated with levetiracetam in a 4 year old girl with respect to seizure control and marked improvement of epileptiform activity in EEG.