Levetiracetam psychosis in children with epilepsy
E H Kossoff1, G K Bergey, J M Freeman
1Department of Neurology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-7247, USA. ekosoff@jhmi.edu
Insights
Levetiracetam, an anticonvulsant, may cause reversible psychosis in children and adolescents. Symptoms like hallucinations and agitation resolved upon dose reduction or discontinuation.
Area of Science:
- Pediatric Neurology
- Pharmacovigilance
- Neuroscience
Background:
- Levetiracetam is an anticonvulsant medication with a unique mechanism of action.
- While generally well-tolerated in adults, adverse psychiatric effects like irritability have been noted.
- Data on levetiracetam's use and side effects in pediatric populations are limited.
Observation:
- This study reports on four pediatric patients who developed acute psychosis after initiating levetiracetam.
- Onset of psychotic symptoms varied from days to months after starting the medication.
- Patients experienced diverse symptoms including visual and auditory hallucinations, agitation, and delusions.
Findings:
- All four pediatric patients exhibited treatment-emergent psychosis, including hallucinations and behavioral changes.
- Psychotic symptoms significantly improved within days after levetiracetam dosage was decreased or the drug was discontinued.
- Pre-existing behavioral issues or cognitive deficits were noted in some patients, but their role in predisposing to psychosis is unclear.
Implications:
- Levetiracetam can induce reversible psychotic side effects in children and adolescents.
- Clinicians should monitor for psychiatric adverse events in pediatric patients taking levetiracetam.
- Further research is needed to determine risk factors, such as rapid initiation or prior neurobehavioral problems, for levetiracetam-induced psychosis.
Purpose:
Levetiracetam is a new anticonvulsant (AED) with a novel mechanism of action. Although it is generally well tolerated with a good cognitive profile, irritability and hostility have been reported in some adults taking levetiracetam. Observations in children are limited; levetiracetam is not yet approved by the Food and Drug Administration for use in children.
Methods:
In four young patients, acute psychosis developed within days to months of initiation of levetiracetam for seizures.
Results:
A 5-year-old girl began having visual hallucinations of spiders in her room 14 days after starting levetiracetam. A 13-year-old boy began having auditory hallucinations, insomnia, and screaming behavior 3 months after initiation of levetiracetam. A 16-year-old girl became acutely agitated, hyperreligious, and had persecutory delusions within 7 days of starting levetiracetam. A 17-year-old girl had auditory hallucinations telling her to sing and yell after 30 days of taking the drug. All four children had dramatic improvement within days of either discontinuing or decreasing the dose of levetiracetam. The three adolescents had historical findings consistent with mild behavioral problems before initiating levetiracetam, and all four patients had prior cognitive deficits.
Conclusions:
Reversible treatment-emergent psychosis associated with levetiracetam therapy was observed in four children and adolescents. Whether rapid initiation or prior neurobehavioral problems predispose to this side effect is not established.
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