Abstracts

Rationale: Levetiracetam (LEV) is widely used in treating patients with epilepsy and is often effective for various types of seizures. A relatively rare adverse neurological event is LEV-induced psychosis, characterized by seething rage, unusual anger, depression, violence, and suicidal tendencies. We report four cases of LEV-induced psychiatric symptoms. Methods: METHOD: Case one was a 20-year-old female. At age 18 years she started to have generalized tonic-clonic seizures (GTCs) and was diagnosed with epilepsy. Soon after starting LEV, she and her family noticed she became irritated, violent toward objects, and moody. Three months after starting LEV she felt depressed and had suicidal tendencies as well as the above symptoms. She took LEV at 1750 mg/day but still had monthly GTCs. She continued to have these symptoms while LEV was tapered. One month after switching from LEV to carbamazepine, all psychotic symptoms disappeared. Case two was a 28-year-old male who started having seizures at age 26 years. He was prescribed LEV at 1000 mg/day after experiencing four secondary GTCs in 6 months. Several hours after he took his first LEV dose, he noticed he was irritable and unusually violent toward objects. He stopped taking LEV after 3 days because of his psychiatric symptoms. His mood recovered in 1 day. His seizures were controlled with lamotrigine at 50 mg/day. Case three was a 33-year-old male. At age 9 years he started having medically intractable GTCs in the morning. At age 33 years he was prescribed LEV with sodium valproate and ethosuximide. Soon after his LEV increased from 250 mg/day to 500 mg/day, his wife complained of his irritability and moods, although he did not notice these changes himself. His symptoms disappeared 2 weeks after stopping LEV. Case four was a 53-year-old male who started having complex partial seizures and GTCs at age 53 years. Soon after he started LEV at 1000 mg/day, his seizures were controlled but he had irritation and difficulty concentrating. His psychiatric symptoms became milder without reducing LEV dose after he was prescribed yokukansan, a traditional Chinese medicine used in Japan. Case five was a 62-year-old female who had intractable complex partial seizures from 3 years of age. She had a past history of pediatric febrile seizure and had temporal psychosis when prescribed phenytoin for seizures at age 38 years. After starting LEV at 1000 mg/day, she complained of general malaise, which continued for 1 month after stopping LEV. After trying LEV at 1000 mg/day again, and she showed psychosis (gustatory hallucinations and delusions of persecution), irritation, and uncontrolled anger. Two weeks after stopping LEV, her psychosis disappeared. A few months after complete withdrawal of LEV, her character was completely recovered. Results: Four of five cases did not have any past history of psychiatric symptoms. Psychiatric symptoms varied, were observed as acute adverse events, and disappeared relatively soon after LEV was stopped. It is important to inform patients and their families about this possible adverse event, as some patients may not recognize their symptoms even though they are noticed by their families. Conclusions: We reported cases in which patients showed psychiatric symptoms, probably due to LEV. It is important to understand the risk of this adverse event and respond appropriately. Funding: No fundings