Abstracts

Rationale: To increase awareness of the paradoxical reaction of levetiracetam (LEV) in generalized epilepsies, which has been rarely reported in literature.Methods: We are reporting two cases seen at Loma Linda University Medical Center of patients with primary generalized epilepsy, who experienced significant paradoxical reactions to LEV by an increase in seizure frequency.Results: C.C.: A 20 year-old female with primary generalized epilepsy, JME type, previously well controlled on phenytoin, was placed on LEV due to gingival hyperplasia while remaining on phenytoin. This led to 15 generalized convulsions in 1 month. C.H.: A 29 year-old female with idiopathic generalized epilepsy (IGE), previously with four healthy pregnancies while on valproic acid (VPA), was taken off VPA during her fifth pregnancy by her obstetrician. After twelve weeks of pregnancy, she was placed on LEV. Three days after initiating therapy of 500mg b.i.d., she experienced generalized convulsions. Three days after increasing the dose to 1,000mg b.i.d., she experienced another generalized convulsion. She was switched back to VPA, and remained seizure free for the last three months of pregnancy.Conclusions: LEV is generally held to be a well-tolerated anti-epileptic agent for primary and secondary generalized epilepsy, particularly during pregnancy. In our case series, we are reporting LEV as an aggravating drug in two patients with primary generalized epilepsies. This finding has been reported to affect patients with mental retardation (Szucs et al., 2008). Additionally, AEDs have been described as an aggravating factor for seizures in idiopathic generalized epilepsies (Chaves et al., 2005). Despite this observation, we continue to use LEV in our epilepsy patients. Caution is advised when transitioning a LEV-naive patient with primary generalized epilepsies.