Levetiracetam
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Behavioral abnormalities: case report A 28-year-old woman developed behavioral abnormalities presenting as agitation, aggressive behavior, hostility, paranoia and suicidal ideation during treatment with levetiracetam for seizure disorder. The woman, who had a history of seizure disorder and bipolar schizoaffective disorder, presented with cluster of tonic-clonic seizures. She was stabilised and her ongoing oral levetiracetam dose was increased from 500mg twice daily to 750mg twice daily, which had been her original dose a few days before presentation. She reported suicidal ideation and a psychiatry consultation was requested to rule out a psychogenic comorbidity. Her mental examination was normal with mild psychomotor retardation. She showed normal speech. Her affect reflected her mood, was stable and reactive. She showed a proper thought process, absent of suicidal or homicidal ideation or intent. She did not show paranoid delusions, perceptual disturbances or abnormal impulse control. Examinations of urine, metabolic panel, blood count and CT scan were all normal. Her urine screen was positive for cannabis. A baseline trough levels of levetiracetam was below therapeutic range and justified her recent increase in dose. She was admitted for observation. Her oral levetiracetam 750mg twice daily was continued, concurrently with risperidone [risperdal], her home medication. However, on day 2 of admission, she became physically and verbally abusive towards the staff and other patients. She persistently banged doors and disrupted the unit. She showed difficulty in processing information and was threatening towards the staff. She was uncontrollable and loud, and required frequent redirection. The woman was treated with medication as needed, due to her aggressive behavior on day 3 of admission. Her speech was pressured and loud. She made many attempts to run from the unit and showed paranoid ideation with beliefs that she was being attacked by her peers and the staff. She also showed suicidal ideation. On day 5 of admission, the neurology team was consulted. A further review did not indicate abnormal neurological findings. Thus, her levetiracetam was discontinued and she was initiated on oxcarbazepine. After stopping her levetiracetam, her aggressive and behavioral symptoms showed a dramatic resolution. She became compliant and calm [not all outcomes stated]. Her oxcarbazepine was continued until discharge. Based on her history, clinical presentation and examinations, she was diagnosed with levetiracetam-induced behavioral abnormalities presenting as agitation, aggressive behavior, hostility, paranoia and suicidal ideation. Ogunsakin O, et al. Levetiracetam Induced Behavioral Abnormalities in a Patient with Seizure Disorder: A Diagnostic Challenge. Case Reports Psychiatry 2020: 2020. 803515495 Available from: URL: http://doi.org/10.1155/2020/8883802
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Reactions 21 Nov 2020 No. 1831
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