Abstracts

Rationale: Drug-induced optic neuropathy has not been previously reported with antiepileptic drug therapy. Blurred vision and double vision have occasionally been reported as side effects of Levetiracetam (LEV). Methods: After 1 month on LEV therapy (brand name) at the dose of 60 mg/kg/day, a 6 year-old white male presented with slowly progressive binocular blurred vision associated with headaches and visual scotoma. Four days later, he could not see in the dark first and bilateral mydriasis was noted. Visual loss became diurnal within a week of onset of visual symptoms. Bilateral papilledema associated with severe visual loss was noted and the child was admitted for further evaluation. Results: Pictures of the optic disk swelling were obtained. Spinal tap showed a normal opening pressure and ruled out metabolic, infectious, autoimmune and inflammatory causes of optic neuropathy. The only CSF abnormality was elevated myelin basic protein (3.21 ng/ml). MRI of the brain with and without contrast was normal. Return of vision to normal was observed one week after discontinuation of LEV therapy and intravenous methylprednisolone 1gm/kg x 1. Conclusions: Levetiracetam-induced optic neuropathy is suspected in our patient. Careful funduscopic exam is recommended in patients treated with LEV complaining of blurred vision