Abstracts

RATIONALE: Levetiracetam is a new anticonvulsant with a novel mechanism of action. Although generally well-tolerated with a good cognitive profile, irritability and hostility have been reported in some adults taking levetiracetam. Observations in the pediatric population are limited; levetiracetam is not yet FDA approved for use in children.
METHODS: Four young patients who developed acute psychosis within several days to months of initiating levetiracetam for complex partial seizures have been identified in the pediatric epilepsy population at a single university center.
RESULTS: A 5 year old girl began having visual hallucinations of spiders in her room 14 days after starting levetiracetam. A 13 year old male began having auditory hallucinations, insomnia, and screaming behavior three months after beginning medications. A 16 year old female became acutely agitated, hyperreligious, and having persecutory delusions within 7 days of levetiracetam. A 17 year old female had auditory hallucinations telling her to sing and yell after 30 days on medications. All four children had dramatic improvement within days of either discontinuing or decreasing the dose of levetiracetam. The three adolescents all had both historical and examination findings consistent with mild behavioral problems prior to initiating levetiracetam and three of the four patients had prior developmental delay.
CONCLUSIONS: Reversible treatment-emergent psychosis associated with levetiracetam therapy was observed in four children and adolescents. This potential side effect needs to be considered in any child on this new anticonvulsant. Whether rapid initiation or prior neurobehavioral problems predispose to this side effect is not established.