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Multifocal myoclonus as a presentation of levetiracetam toxicity
Mei Bou Nasif1, Shweta Varade1, Mohamad Z Koubeissi1
1Department of Neurology, George-Washington University, Washington, DC, USA.
Background:
Levetiracetam (LEV) is widely used for treatment of focal and myoclonic seizures, but reports of LEV toxicity are scarce. Here, we report a rare case of multifocal myoclonus due to LEV toxicity in a patient with chronic renal insufficiency.
Case Presentation:
A 52-year-old woman with history of chronic kidney disease was admitted to the ICU for sedation and intubation after a cardiac arrest. She developed nonconvulsive status epilepticus that resolved after administration of propofol while receiving LEV 1500 mg twice a day. After holding the propofol infusion, the patient started having multifocal myoclonic jerks, documented on video-EEG recordings with a supratherapeutic level of LEV. After discontinuation of LEV, the myoclonus resolved.
Conclusion:
This is a unique manifestation of LEV toxicity, which has been scarce in the literature. It suggests an inverted U-shaped dose-response of the antimyoclonic effect of LEV.
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