Reactions 1680, p201 - 2 Dec 2017 Psychiatric disorders: 2 case reports In a case series, a 31-year-old man developed progressive apathy, anxiety, confusion, paranoid delusion and bizarre behaviour, and a 53-year-old man developed bizarre aggressive behaviour during therapy with levetiracetam [routes and time to reaction onsets not stated]. Patient 1: The 31-year-old man with apathetic behaviour was hospitalised after having two secondarily generalised seizures. For the treatment of generalised seizures, he started receiving levetiracetam 750mg twice daily for 6 months. Subsequently, he was diagnosed with oligodendroglioma. He then underwent a surgery of the oligodendroglioma. On post- operative day 6, he showed motor restlessness. The motor restlessness was interpreted as complex-partial-seizure. Hence, the levetiracetam dosage was increased to 1000mg twice daily. Thereafter, he developed progressive apathy and distrust to an acceptable level, he was discharged on the postoperative day 9. However, instead of leaving the hospital, he returned to the ward, anxious and confused. He showed paranoid delusions and bizarre behaviour. An EEG demonstrated diffuse slowing asymmetric activity in the right hemisphere, with a focal abnormality in the right frontal lobe, not suspect for focal or generalised epileptiform activity. His psychiatric manifestations were suspected to be due to the levetiracetam. The man’s levetiracetam was reduced initially and finally switched to valproate. Within few days, his behaviour normalised. He was discharged after 7 days of the medication switch. At a follow-up after 6 weeks, he was seizure free and showed no psychiatric symptoms. Patient 2: The 53-year-old man was admitted with a sudden collapse and loss of consciousness. He was then suspected with a secondarily generalised seizure. He then received therapy with levetiracetam 750mg twice daily for the prevention of further seizures. He was subsequently diagnosed with oligodendroglioma. He then underwent a surgery of the oligodendroglioma. On post-operative day 5, he was discharged in a good clinical condition. In the week after hospital discharge, his behaviour gradually changed. He showed bizarre behaviour; he demanded strict obedience. He demonstrated an intimidating and verbally aggressive behaviour. He also threatened others with violence. He was admitted subsequently. His aggressive behavioural manifestations were suspected to be due to the levetiracetam administration. The man’s levetiracetam was reduced and switched finally to valproate. After the initiation of valproate, his behaviour returned to normal. Thereafter, he was discharged. At a follow-up after 6 months, his behaviour was still normal. Author comment: "Two patients, treated with levetiracetam, developed serious psychiatric complications postoperatively which completely resolved after switching to valproate." ’We aim to create awareness for this serious but reversible adverse effect of levetiracetam in this specific patient category." Habets JGV, et al. Serious and reversible levetiracetam-induced psychiatric symptoms after resection of frontal low-grade glioma: two case histories. British Journal of Neurosurgery 31: 471-473, No. 4, Aug 2017. Available from: URL: http://doi.org/10.1080/02688697.2016.1244255 - Netherlands 803284004 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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