Levetiracetam (Lev) is a new antiepileptic drug with a distinct mechanism of action, shown in regulatory trials to be effective. These controlled trials do not always predict how useful a drug will be in day to day clinical practice. Retention rates can provide a better indication of efficacy and tolerability in everyday use. Patients attending a tertiary referral centre for epilepsy and who received Lev in the first 2 years of its marketing were assessed (n = 811) to determine continuation rates of treatment with this drug. At the last follow up, 65% of patients were still taking Lev, and the estimated 3 year retention rate was 58%. In total, 11% attained seizure freedom of at least 6 months. Patients taking greater numbers of concurrent antiepileptic drugs (AEDs) were more likely to discontinue Lev, and those reaching higher maximum daily dosages were less likely to discontinue Lev. The retention rate for Lev compares favourably with that of other new AEDs. L evetiracetam (Lev) is one of several antiepileptic drugs (AEDs) that have recently emerged for the adjunctive treatment of focal onset epilepsy. It was licensed as add on treatment for refractory focal epilepsy in adults in the UK in 2000. Lev is an S renantiomer pyr-olidone derivative with a distinctive pharmacological profile in animal models of seizures and epilepsy.1 It is not affected by drug-drug interactions and has a generally mild side effect profile. Lev was recently shown to act through binding to and modulation of the synaptic vesicle protein SV2A, 2 which is thought to play a crucial role in vesicle function. Thus, Lev is fundamentally different from other AEDs, and its efficacy and tolerability profiles may also differ.There are issues regarding the efficacy and safety of new AEDs, which have not been identified in regulatory trials.3 In total, 11 new AEDs have been licensed worldwide in the past 20 years, of which three (progabide, felbamate, and vigabatrin) developed safety problems, requiring prompt recall of patients to minimise morbidity. 4 These problems developed after launch despite years of clinical trials, indicating the need for close monitoring of people exposed to such drugs, both to identify potential problems and to enable swift recall of patients. Additionally, it has transpired that some of these new AEDs have had little clinical impact, and now have only a small role in the treatment of people with epilepsy. It is important, therefore, that the clinical efficacy profile of these drugs in every day use is identified early, to instruct good clinical practice and thereby to improve the quality of life and wellbeing of people with epilepsy.While the efficacy and tolerability of Lev have been demonstrated in several controlled regulatory trials, few studies have addressed long term continuation in a large group of patients in a clinic setting. This assessment aimed to determine the long term retention of treatment with Lev as a surrogate for efficacy and safety in a large group of patients in a single centre, to inform our futur...

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Tricyclic antidepressants -third-line treatment for attention deficit hyperactivity disorder in school-aged children Tricyclic antidepressants for attention deficit hyperactivity disorder in children and adolescents. 1