Gingival enlargement following levetiracetam treatment: A clinical case analysis

This report describes a 21-year-old female with a history of epilepsy, diagnosed at age 17, who developed gingival enlargement after being treated with levetiracetam. Her dosage was titrated to 750 mg twice daily, achieving satisfactory seizure control. Regular neurological evaluations and laboratory tests remained within normal limits for 3 years. However, the patient subsequently reported increased gingival size and a perception that her teeth appeared smaller. Examination confirmed gingival enlargement, with no other medications or underlying conditions contributing to this side effect. Genetic testing did not reveal any predisposition to gingival enlargement. Following a careful review, levetiracetam was tapered, and the patient was transitioned to lamotrigine. Dental evaluation suggested surgical intervention for cosmetic purposes. This case highlights the importance of counseling and monitoring for gingival enlargement as a notable side effect of levetiracetam. PLAIN LANGUAGE SUMMARY: A 21-year-old woman diagnosed with epilepsy at 17 experienced gingival enlargements after being treated with levetiracetam at 750 mg twice daily, which effectively controlled her seizures. While her neurological evaluations remained normal for 3 years, she later reported that her gingiva appeared larger, making her teeth look smaller. Comprehensive investigations, including genetic testing, showed no genetic predisposition to this issue. Following a careful review of her treatment, her levetiracetam dosage was lowered, and she was switched to lamotrigine. A dental evaluation recommended surgery for cosmetic improvement, emphasizing the importance of monitoring for gingival enlargement as a potential side effect of levetiracetam.