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Celli D, Marquez A, Byer M, Colombo R. Levetiracetam for the treatment of myoclonic neurotoxicity induced by amiodarone. HeartRhythm Case Rep 2020; 6:488-490. [PMID: 32817824 PMCID: PMC7424226 DOI: 10.1016/j.hrcr.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Altınöz AE, Tosun Altınöz Ş, Güzel Biltekin B, Can Kaya M. Levetiracetam induced hypomania: a case report. Ther Adv Drug Saf 2019; 10:2042098619876754. [PMID: 31620273 PMCID: PMC6777046 DOI: 10.1177/2042098619876754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 08/26/2019] [Indexed: 11/25/2022] Open
Abstract
Levetiracetam (LEV) is a newer second-generation antiepileptic drug that is found
to be effective in tonic-clonic seizures, partial onset seizures, and myoclonic
seizures. Among antiepileptic drugs, LEV is usually known for fewer adverse drug
reactions. Psychiatric disorders after the administration of LEV have been
reported in the literature. There are many case reports on LEV-induced
psychosis, but there are only three case reports of mania induced by LEV use. In
this report, we present a case with no history of psychiatric disorder who had a
hypomania episode after receiving LEV for epilepsy treatment. The development of
manic symptoms with LEV therapy is unusual. Clinicians should consider
monitoring patients closely for treatment-related psychological symptoms and
psychotic symptoms, including the possibility of mania.
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Affiliation(s)
- Ali Ercan Altınöz
- Department of Psychiatry, Eskisehir Osmangazi Universitesi Tip Fakultesi, Eskisehir 26480, Turkey
| | - Şengül Tosun Altınöz
- Department of Psychiatry, Yunus Emre Devlet Hastanesi 2 Eylul Hizmet Binasi (Eski Hava Hastanesi), Eskisehir, Turkey
| | | | - Murat Can Kaya
- Department of Psychiatry, Eskisehir Osmangazi Universitesi Tip Fakultesi, Eskisehir, Turkey
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Abstract
Levetiracetam is an antiepileptic agent that is used for partial and generalized epilepsy. Although it is well tolerated in most cases, behavioral and nonbehavioral adverse effects may be observed. Among behavioral symptoms, depression, hostility, and agitation have been frequently reported. However, mania or mania-like symptoms are relatively rare, especially in children and adolescents. Hereby, we report mania-like symptoms with levetiracetam use in a 15-year-old boy. Mania-like symptoms emerged 3 weeks after starting levetiracetam and disappeared after adding risperidone to ongoing levetiracetam treatment.
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Suresh SH, Chakraborty A, Virupakshaiah A, Kumar N. Efficacy and Safety of Levetiracetam and Carbamazepine as Monotherapy in Partial Seizures. EPILEPSY RESEARCH AND TREATMENT 2015; 2015:415082. [PMID: 26798511 PMCID: PMC4698781 DOI: 10.1155/2015/415082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/01/2015] [Indexed: 11/18/2022]
Abstract
Introduction. Levetiracetam (LEV) is a newer antiepileptic drug with better pharmacokinetic profile. Currently, it is frequently used for the treatment of partial seizures. The present study was undertaken to compare the efficacy and safety of LEV and Carbamazepine (CBZ) in partial epilepsy. Methods. This was a prospective, open labeled, randomized study. It was conducted in participants suffering from partial seizures after the approval of ethics committee and written informed consent. The first group received Tab LEV (500 to 3000 mg/day) and the second group received Tab CBZ (300 to 600 mg/day). The primary outcomes were efficacy and safety. The secondary outcome was the Quality of Life (QOL). Efficacy was assessed by comparing the seizure freedom rates at the end of 6 months. Safety profile was evaluated by comparing the adverse effects. QOL was assessed by QOLIE-10 scale. Results. The overall seizure freedom rate at the end of 6 months was 71.42% in CBZ group compared to 78.57% in LEV group (p = 0.2529). Both LEV and CBZ reported a similar incidence of adverse reactions. LEV group reported more behavioral changes like increased aggression and anxiety. Also, it showed better QOL compared to the CBZ group. Conclusion. LEV monotherapy and CBZ monotherapy demonstrated similar efficacy for treatment of partial epilepsy and were found to be well tolerated.
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Affiliation(s)
| | - Ananya Chakraborty
- Department of Pharmacology, Vydehi Institute of Medical Sciences and Research Centre, No. 82 EPIP Area, Whitefield, Bangalore 560037, India
| | - Akash Virupakshaiah
- Department of Pharmacology, Vydehi Institute of Medical Sciences and Research Centre, No. 82 EPIP Area, Whitefield, Bangalore 560037, India
| | - Nithin Kumar
- Department of Neurology, Columbia Asia Hospital, Whitefield, Bangalore 560066, India
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Kumar N, Swaroop HS, Chakraborty A, Chandran S. Levetiracetam induced acute reversible psychosis in a patient with uncontrolled seizures. Indian J Pharmacol 2014; 46:560-1. [PMID: 25298593 PMCID: PMC4175900 DOI: 10.4103/0253-7613.140599] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/22/2014] [Accepted: 07/27/2014] [Indexed: 11/10/2022] Open
Abstract
Levetiracetam (LEV) is a relatively newer antiepileptic drug with novel mechanism of action. It was introduced to the market in the year 2000. Pre-marketing clinical trials of the drug reported good tolerability with a wide safety margin. On post-marketing updates, there are few reports of psychosis after treatment with the drug. Here, we report a case of 52-year-old epileptic man who developed acute, reversible psychosis within 3 days of initiation of treatment. The drug was prescribed at a dose of 500 mg per day. After 3 days of treatment, the patient developed visual hallucinations, mood swings, withdrawal and suspicious behavior. Delirium was ruled out as there was no fluctuation in his sensorium or focal neurological deficits. His lab investigations for electrolytes, renal function test, thyroid, liver function and other related tests levels were within normal limits. A diagnosis of LEV induced psychosis was reached based on clinical judgment and causality assessment.
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Affiliation(s)
- Nithin Kumar
- Department of Neurology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - H S Swaroop
- Department of Pharmacology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Ananya Chakraborty
- Department of Pharmacology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Suhas Chandran
- Department of Neurology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
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Zaki SA, Gupta S. Levetiracetam-induced acute psychosis in a child. Indian J Pharmacol 2014; 46:341-2. [PMID: 24987186 PMCID: PMC4071716 DOI: 10.4103/0253-7613.132195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/28/2013] [Accepted: 03/20/2014] [Indexed: 11/18/2022] Open
Abstract
Levetiracetam is well-tolerated and commonly used as a broad spectrum antiepileptic in both partial and generalized seizures. Few cases of levetiracetam-induced psychosis in children are reported in the literature. The present case of levetiracetam-induced acute psychosis highlights the adverse effect of this drug and also emphasizes the need for close monitoring of children on levetiracetam.
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Affiliation(s)
- Syed Ahmed Zaki
- Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India
| | - Saurabh Gupta
- Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India
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Eisenschenk S, Krop H, Devinsky O. Homicide during postictal psychosis. EPILEPSY & BEHAVIOR CASE REPORTS 2014; 2:118-20. [PMID: 25667886 PMCID: PMC4307965 DOI: 10.1016/j.ebcr.2014.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 04/04/2014] [Accepted: 04/06/2014] [Indexed: 11/09/2022]
Abstract
Postictal psychosis is characterized by a fluctuating combination of thought disorder, auditory and visual hallucinations, delusions, paranoia, affective change, and aggression including violent behavior. We present a case of homicide following a cluster of seizures. The patient's history and postictal behavior were his consistent with postictal psychosis. Contributing factors resulting in homicide may have included increased seizure frequency associated with a change in his AED regimen seizure frequency. The AED change to levetiracetam may also have increased impulsiveness with diminished mood regulation following discontinuation of carbamazepine. There is evidence that he had a cluster of seizures immediately prior to the murder which may have resulted in the postictal disinhibition of frontal lobe inhibitory systems. This homicide and other violent behaviors associated with postictal psychosis may be avoided with earlier recognition and treatment.
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Affiliation(s)
- Stephan Eisenschenk
- Department of Neurology, University of Florida, 1149 Newell Drive, Rm L3-100, Gainesville, FL 32611, USA
| | - Harry Krop
- Community Behavioral Services, 1212 N.W. 12th Ave., Ste. B, Gainesville, FL 32601, USA
| | - Orrin Devinsky
- Department of Neurology, NYU School of Medicine, 223 East 34th Street, New York, NY 10016, USA
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Siemianowski LA, Rosenheck JP, Whitman CB. Nalbuphine-induced psychosis treated with naloxone. Am J Health Syst Pharm 2014; 71:717-21. [PMID: 24733134 DOI: 10.2146/ajhp130485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A case of nalbuphine-induced psychosis, which resolved after the administration of naloxone, is described. SUMMARY A 25-year-old African-American woman with a history of systemic lupus erythematosus was admitted to the hospital for management of cholecystitis. A laparoscopic cholecystectomy was performed, and the patient received multiple doses of i.v. hydromorphone for postoperative pain management. Four days later, shortly after receiving a dose of i.v. nalbuphine for opioid-induced pruritus, she experienced an acute psychotic event, with symptoms including intense headache, akathisia, altered mental status, and formication (a hallucinatory sensation of insects crawling on the skin). The neuropsychiatric symptoms abated within 5 minutes of two consecutively administered doses of i.v. naloxone. During this event, which lasted 25-30 minutes, there was no evidence of metabolic abnormalities and were no signs of infection. The patient did not have a history of mental illness or substance abuse. The patient did not receive further doses of nalbuphine and did not experience similar events during her hospital stay; she was discharged home 10 days later without further complications. According to the algorithm of Naranjo et al., the case was assigned a score of 6, indicating a probable adverse reaction to nalbuphine. CONCLUSION A patient developed an acute psychotic reaction that was probably secondary to administration of i.v. nalbuphine for opioid-induced pruritus. Evidence supporting this diagnosis included correlation between the timing of administration of nalbuphine and symptom onset and the marked improvement in mentation following the administration of naloxone.
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Affiliation(s)
- Laura A Siemianowski
- Laura A. Siemianowski, Pharm.D., is Assistant Professor of Clinical Pharmacy, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA. Justin P. Rosenheck, D.O., is Postgraduate Year 3 Internal Medicine Resident, Cooper University Hospital, Camden, NJ. Craig B. Whitman, Pharm.D., is Clinical Pharmacist, Surgical, Burn and Trauma ICU, Barnes Jewish Hospital, St. Louis, MO
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