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Behavioral side-effects of levetiracetam in children with epilepsy: a systematic review
Elisabeth Halma1, Anton J A de Louw1, Sylvia Klinkenberg2
1Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.
Insights
Levetiracetam, an epilepsy medication, may cause behavioral side effects like aggression in children. This review highlights the frequency and types of these adverse events in pediatric epilepsy patients.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacy
Background:
- Children with epilepsy exhibit higher rates of behavioral issues.
- Levetiracetam is frequently used for epilepsy management in children.
- Existing literature suggests potential behavioral side effects associated with levetiracetam.
Purpose of the Study:
- To systematically review and quantify the frequency and types of behavioral side effects in children with epilepsy treated with levetiracetam.
- To provide a comprehensive overview of levetiracetam-induced behavioral adverse events in pediatric populations.
Main Methods:
- Systematic review of studies identified through PubMed, Medline, Cochrane, and Embase.
- Inclusion criteria: children (1 month-18 years) with epilepsy, levetiracetam use, stable concomitant AEDs, reported behavioral side effects, and ≥2 weeks follow-up.
- Quality assessment and data extraction were performed on 13 eligible studies.
Main Results:
- 13 studies with 727 patients were included. Randomized controlled trials (RCTs) reported 62 behavioral side effects in 203 patients, leading to discontinuation in 2.0%.
- Common side effects included hostility, nervousness, and aggression. Meta-analysis indicated a significant relative risk (2.18) for behavioral side effects with levetiracetam versus placebo.
- Observational studies presented varied results, with some showing behavioral improvements and others deteriorations.
Conclusions:
- Children with epilepsy treated with levetiracetam have an increased risk of behavioral side effects, including aggression, hostility, and nervousness.
- These findings underscore the importance of monitoring for behavioral changes during levetiracetam therapy in pediatric epilepsy patients.
Purpose:
Children with epilepsy are more likely to have behavioral problems compared to children without epilepsy. Literature suggests that levetiracetam leads to behavioral side-effects in children with epilepsy. The objective of this study is to provide a better overview of the frequency and variety of behavioral side-effects, which can be initiated by levetiracetam therapy in children with epilepsy.
Method:
Electronic databases used in the search were PubMed, Medline, Cochrane and Embase. Studies were eligible for inclusion when they included children from one month to 18 years of age with a diagnosis of epilepsy, used levetiracetam, had other AEDs on a stable regimen for at least two months, reported about behavioral side-effects and had a follow-up of at least two weeks. Quality assessments and data collection were carried out for all eligible studies.
Results:
Thirteen studies, including 727 patients using levetiracetam, were included in this systematic review. Three randomized controlled trials showed a total of 62 behavioral side-effects in 203 patients, effects which led to discontinuation of levetiracetam in only two of 102 patients (2.0%). Hostility, nervousness and aggression were reported mostly. Meta-analysis showed a statistically significant relative risk of 2.18 for the total number of behavioral side-effects for levetiracetam versus placebo. Observational studies showed mixed results with both behavioral deteriorations and improvements following levetiracetam.
Conclusion:
Based on the findings in this systematic review, children using levetiracetam have a risk of developing several behavioral side-effects such as aggression, hostility and nervousness compared to children who do not use levetiracetam.
