Levetiracetam Induced Behavioral Abnormalities in a Patient withSeizure Disorder: A Diagnostic Challenge

Levetiracetam is a second-generation antiepileptic drug that is chemically unrelated to other antiepileptic drugs. Levetiracetam is abroad-spectrum antiseizure medication that is approved as an adjunctive therapy in the treatment of partial and generalized tonic-clonic seizures in children and adults with epilepsy. The mechanism by which Levetiracetam induces behavioral changes remainsunknown. Its proposed mechanism of action involves binding to synaptic vesicle protein 2A (SV2A) and this leads to neuronalinhibition. Though, the drug has a convenient dosing regimen and is relatively well tolerated, neuropsychiatric side effects canemerge beyond the initial titration period and may be the most common reason for drug discontinuation. Levetiracetam hasbeen reported to cause varying degrees of psychiatric adverse effects including behavioral disturbance such as agitation, hostilityand psychosis, and mood symptoms and suicidality. It has been shown to induce psychiatric side effects in 13.3% of adults, withonly 0.7% presenting with severe symptoms such as depression, agitation, or hostility. The prevalence rate of development ofpsychosis in these patients is estimated to be about 1.4%. A review of literature has demonstrated a relative correlation betweenLevetiracetam use and the development of neurobehavioral symptoms which is increased in predisposed individuals. Thisresearch describes the case of a 28-year-old woman with seizure disorder and a psychiatric history of schizoaffective disorderwho developed aggressive behavior, paranoia, and severe hostility following administration of Levetiracetam 750 mg orally twicedaily. She developed acute behavioral symptoms which were reversed with cessation of Levetiracetam. This report emphasizesthe need for developing an appropriately high index of suspicion in promoting surveillance and prompt identification ofbehavioral adverse effects associated with Levetiracetam especially in high-risk patient population.