Obsessive-Compulsive Behavior Induced by Levetiracetam

Abstract

A novel antiepileptic drug, levetiracetam, has been reported to cause several psychiatric adverse effects in spite of its effectiveness on epilepsy. However, a possible relationship between levetiracetam and obsessive-compulsive behavior has only been reported in a few studies with adult epilepsy patients. We treated a pediatric patient with epilepsy without past or family history of psychiatric disorder. Levetiracetam was started to control generalized tonic-clonic seizure. Two months after initiation of levetiracetam with favorable seizure control, she started to show an obsessive-compulsive behavior such as repetitive checking of her back, pants, and chair. Based on the course of its appearance, levetiracetam administration was identified as a possible cause. After termination of levetiracetam, her obsessive-compulsive behavior completely disappeared with reappearance of seizures. This case provides clear evidence that levetiracetam may cause obsessive-compulsive behavior even in a pediatric epilepsy patient without psychiatric background, possibly mediated by modulation of the glutamate system by levetiracetam.

Relationship of levetiracetam and obsessive-compulsive disorder: a case report

“…In a case report, a 14-yearold female epilepsy patient was reported to show obsessive-compulsive disorder following the addition of levetiracetam 1500 mg/day to carbamazepine therapy [14]. Following the levetiracetam treatment, seizure control was ensured, but the patient started to show obsessive-compulsive behaviour, which lasted for a significant amount of time every day.…”

Sapap3 deletion causes dynamic synaptic density abnormalities: a longitudinal [11C]UCB-J PET study in a model of obsessive–compulsive disorder-like behaviour

“…However, a possible role for SV2A itself driving compulsions was previously demonstrated in a clinical setting. Epilepsy patients were shown to develop compulsive behaviours upon administration of the SV2A-targeting antiepileptic drug levetiracetam [42,44,45,74].…”

“…Also from a clinical point of view, there is emerging-mainly genetic-evidence for "synaptopathies" as a hallmark in the development of OCD [32][33][34][35][36] and other neuropsychiatric diseases [37][38][39][40][41]. Moreover, the SV2A targeting antiepileptic drug levetiracetam [42] was associated earlier with adverse psychiatric reactions, including the occurrence of obsessive-compulsive behaviours [43][44][45]. Differently, another case report demonstrated the ability of levetiracetam to treat a refractory OCD patient [46].…”

Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management

“…Brain changes (i.e., asymmetry or thickness of subcortical structures, parietal cortex thickness, others) can be influenced by various factors such as genetics, age, anti-OCD medication effects and others (63,64). Obsessive-compulsive behavior has been anecdotally reported in some taking the anti-epileptic drug, levetiracetam, possibly because of effects on the glutamatergic system (65).…”