[dampex]

First of all, thak you very much Suvash for your pondered intervention.

You’re right when you say I gave insufficient information about patient’s history. I was so interested about collateral effects of levetiracetam and the possibility that these were noted by other clinicians, so I haven’t explained previous pharmacological and psychosocial treatments interesting A. (Privacy Law!), 79 years, male.
History: recurrent bronchitis (last episode 10/2005), no other significant pathologies untill 2004, when A. shows an Aphasic T.I.A. and parents told this event like starting point of cognitive impairment. In 2005, after neurologic evaluation (clinical, brain CT, laboratory examinations,...), there was a mixed dementia diagnosis (MMSE 12/30). Therapy was based about aceticholinesterase inhibitors (donepezil), ambiental therapy (functional recovery in everyday duties,...) and educational support for the family. But things, progressively, goes bad... Cognitive impairment (MMSE 8/30) was followed by sensory-motor impairment and BPSD (high aggressiveness, depression, ansious state, presence of opposition). Donepezil was stopped because without benefical effects and for arousal effect evidencied on behaviour. Now A. shows aphasia, significative psychomotor slowing, full functional dependence, double incontinence, adequate nutrition, renal and hepatic functions are good. A. is currently in Alzheimer Unit, where I follow him with other clinicians, and his family went in our hospital specifically to manage exacerbated aggressiveness (because they want to treat A. at home at discharge).
Current pharmacological therapy is very simple and based about cardioaspirin, an SSRI, zolpidem for the night, and prior levetiracetam, but this has caused chronic lowering of vigilance, despite lowering of aggressiveness. You must know that quetiapine, olanzapine were ineffective in adequate treating A. BPSD. I was thinking about others AED, like gabapentin, lamotrigine or valproic acid, because their behaviour stabilizing effects... also i was interested if anybody has experimented this kind of effect with low dosages of levetiracetam (before never seen in our hospital...).

I thank you again for your precious advices, damiano.

P.S. I beg your pardon for my bad English, I think writing to xenomed forums is a good exercise to improve...