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Background: Levetiracetam (LEV) is a new generation anti-epileptic drug, which has been approved as add-on therapy for partial epilepsy. The mechanism of LEV is not yet completely understood., Aim: To evaluate the efficacy and tolerability of LEV in adult patients with refractory epilepsy., Methods: We report the results of 49 patients with refractory epilepsy, with partial and generalized seizures, who received LEV as an add-on treatment, in two tertiary medical centers. There were 27 males, mean age 35.4+13 years. The average duration of epilepsy was 21 + 11 years, the average seizure rate was 31 + 30 per month. The patients were treated with a mean of 2.6 AED when LEV was introduced. The patients were treated for 12.6 + 9.7 months with an average dose of 1964 + 743.7 mg LEV per day., Results: Five (10%) patients became seizure free, 12 (25%) responded with seizure reduction of more than 50% following the introduction of LEV, 8 (16%) responded with seizure reduction of less than 50%, no response to LEV was reported in 20 (41%) and seizure aggravation occurred in 4 (8%). No serious persistent adverse events were reported. The main side effect was drowsiness in 10% of patients., Conclusion: The results of this study, as well as previous studies, suggest that LEV is a well-tolerated new antiepileptic drug, and as an add-on therapy it may effectively improve seizure control in patients with intractable epilepsy.