Abstracts

Anecdotal observations have been reported on disordinate incidence of adverse behavioural effects in patients with epilepsy, treated with levetiracetam (LEV). Little was written on improvement of the behavioural problems in patients with epilepsy. Herein we present a small population of mentally retarded patients with epilepsy and behavioural problems who responded well to the treatment with LEV, and who showed a significant improvement in their behaviour.
Medical records of 6 patients with refractory seizures and behavioural problems were reviewed retrospectively. Behavioural problems are defined here as significant hostility, verbal or physical aggression against people as reported by patients, relatives or caregivers.
We identified 6 patients with refractory epilepsy due to congenital encephalopathy: 1 tuberous sclerosis, 1 post-vaccine encephalitis, and 4 without known origin, all aged between 23 and 60 years old. They were treated with different regimens, mostly valproic acid and carbamazepine. However, they had severe, even unbearable behavioural disorders, without physical violence. They showed hyperactivity-impulsivity / stereotyped movement disorders / conversion disorders (among which non-epileptic seizures), disinterest, even total contempt for other people and their environment; and had an abandonmental, tyrannical, and self-centred behaviour. Machiavellian in their way of manipulating people around them, they provoked rejection and ruptures (divorce and family psychotherapy).
After administration of levetiracetam (in add-on or in replacement of one of the treatment components), a significant improvement of socialisation, renewed interest in their immediate environment, and better participation were observed from 5 months to more than 6 years with effect maintenance. The patients showed radical change in their behaviour, disappearance of the above-mentioned symptoms, and became interested, mischievous, even worried for their relatives, eager to understand and discover, participating.
These observational data suggest that LEV can have a positive development on behavioural disturbances in mentally retarded patients with epilepsy. This should encourage a study in a larger population to better determine in which patients this positive evolution in behaviour can be expected.