Levetiracetam as a cause of delirium in elderly patient: A case report

Abstract

Levetiracetam is a second-generation anticonvulsant. Delirium is not a well-known adverse effect of the drug. We present the report of an 80-year-old woman with a history of schizophrenia for 45 years and memory impairment for two years, who presented with worsening of confused, disoriented behaviour with sundowning, after being started on Tab. Levetiracetam for late-onset seizures. Examination revealed disorientation, fluctuation in the level of consciousness, impaired attention and psychotic symptoms. Physical examination was normal, except for gait disturbance. Relevant blood, urine and CSF investigations were also normal. Neuroimaging showed diffuse atrophy and small vessel ischemic changes. No focus of infection or metabolic imbalances could be identified. The possibility of delirium due to levetiracetam was suspected and, on cross-titration with sodium valproate, her delirium cleared. This report highlights that levetiracetam can cause delirium in the elderly, which brings forth the need for close monitoring while prescribing medicines in this population.

Delirium Research in India: A Systematic Review

“…A total of 58 case reports/series have focused on delirium as the primary outcome/issue (►Table 8). Some of these case reports have reported association of delirium with medications such as levetiracetam, 92 levofloxacin, 93,94 fluoroquinolones, 95 zoledronate, 96 a combination of albendazole and ivermectin, 97 and use of cyclopentolate eye drops. 98 One report presented information about delirium associated with bath salts.…”