Levetiracetam Induced Neuropsychiatric Manifestation in a 5-year-old Boy

Excerpt

To the Editor: A five-year-old developmentally normal boy presented with six episodes of seizures (Generalized tonic-clonic) for last 6 mo. He was initially started on phenytoin but later switched over to levetiracetam (30 mg/kg) because of poor seizure control. Two weeks after starting of levetiracetam, the child had a change in behavior like poor attention, poor concentration span and decreased interaction with others. Three weeks later, he had intermittent episodes of crying and shouting and hitting other family members without any reason. He also had suicidal tendencies in the form of attempts to cut his wrist with a knife and self-strangulation with a belt. Evaluation for vasculitis (complete blood counts and anti-nuclear antibody), autoimmune encephalitis, worsening epilepsy and other structural etiologies were unremarkable (normal awake and sleep electroencephalography and MRI brain with MR-angiography). Clinical diagnosis of genetic generalised epilepsy was considered. A possibility of levetiracetam induced neuropsychiatric side-effects was considered and levetiracetam was switched over to topiramate. Within few days, he had improvement in interaction with parents, sleep, and behavior. Improvement in symptoms following the withdrawal of levetiracetam suggested a probable causality. He was discharged after 1 wk, and he remained symptom-free over the next 3 mo. …