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Consciousness disturbance: case report An 82-year-man developed consciousness disturbance during treatment with levetiracetam and carbamazepine for epileptic seizure. The man was referred to a hospital to increase the antiepileptic drug dosage for long-term use. He had a history of atrial fibrillation and multiple cerebral infarctions (had a right frontal cerebral infarction 5 years ago and left temporal lobe infarction prior to presentation to the hospital). Following the occurrence of cerebral infarction two years ago, he developed aphasia and right hemiclonic convulsion which were diagnosed as epileptic seizure. His aphasia and right hemiclonic convulsion disappeared following the administration of oral levetiracetam 500 mg/day dry syrup. Two months prior to the referral, he was admitted to a tertiary care center with a diagnosis of right cerebellar infarction and subsequently experienced right conjugate deviation and clonic movement in the right upper and lower limbs. Additionally, he showed consciousness disturbance with a score of 2-20 on the Japan coma scale (JCS). After administration of diazepam, his clonic movement disappeared spontaneously, but the consciousness disturbance did not improve. An electroencephalogram showed slow waves mainly in F3. Fosphenytoin [fosphenytoin sodium hydrate] and sodium valproate were sequentially administered. Over the course of 2 months, these drugs were replaced with zonisamide and levetiracetam 1000 mg/day. Delta waves were observed and the consciousness disturbance did not improve (JCS 2-10 to 2-30). He was then transferred to the hospital to increase the antiepileptic drug dosage for long-term use. He had a right renal infarction 2 months before referral to the hospital. After the renal infarction, his estimated glomerular filtration decreased and did not increase thereafter. His consciousness score on admission was JCS 2-30, and there were no abnormalities in his vital signs. Laboratory investigations revealed renal function failure and a normal complete blood count and liver function. Three months prior to the hospital change, his serum albumin level was decreased. His blood glucose level was found to be 123 mg/dL. No other electrolyte abnormality was found. In addition to levetiracetam, he was prescribed azosemide, tamsulosin, lansoprazole, ursodeoxycholic-acid, rosuvastatin [rosuvastatin calcium] and warfarin. His state of consciousness did not improve after the hospital change. Thirteen-days after the hospital transfer, his nasogastric tube was removed. Levetiracetam and other drugs were discontinued based on directions from the patient and his family. He was continued on maintenance infusions [specific drug not stated]. His JCS improved to 1-3 on day 14 and to 1-1 on day 15. He was able to speak. Endoscopy did not reveal any sign of dysphagia, and he started eating food. The man received oral levetiracetam 500mg in the evening of day 19. He did not wake up the next morning and had a consciousness score of JCS 3-200, indicating that he was unconscious. There w