Psychiatric Symptoms and Quality of Life in Patients with Drug-Refractory Epilepsy Receiving Adjunctive Levetiracetam Therapy

Abstract

Background and PurposeLevetiracetam (LEV) is a new antiepileptic drug that has been found to be effective as an adjunctive therapy for uncontrolled partial seizures. However, the results of several studies suggested that LEV has negative psychotropic effects, including irritability, aggressiveness, suicidality, and mood disorders. We investigated the impact of adjunctive LEV on psychiatric symptoms and quality of life (QOL) in patients with drug-refractory epilepsy (DRE) and determined the risk factors provoking psychiatric adverse events.MethodsA 24-week, prospective, open-label study was conducted. At enrollment, we interviewed patients and reviewed their medical charts to collect demographic and clinical information. They were asked to complete self-report health questionnaires designed to measure various psychiatric symptoms and QOL at enrollment and 24 weeks later.ResultsSeventy-one patients were included in the study, 12 patients (16.9%) of whom discontinued LEV therapy due to serious adverse events including suicidality. The risk factor for premature withdrawal was a previous history of psychiatric diseases (odds ratio 4.59; 95% confidence interval, 1.22-17.32). LEV intake resulted in significant improvements in Beck Anxiety Inventory score (p<0.01) and some domains of the Symptom Checklist-90-Revised, such as somatization (p<0.05), obsessive-compulsiveness (p<0.05), depression (p<0.05), and anxiety (p<0.05). These improvements were not related to the occurrence of seizure freedom. The Quality of Life in Epilepsy Inventory-31 overall score and subscale scores, such as seizure worry (p<0.01), overall QOL (p<0.05), emotional well-being (p<0.05), energy-fatigue (p<0.05), and social function (p<0.05), also improved.ConclusionsAdjunctive LEV in patients with DRE is likely to improve psychiatric symptoms and QOL. Clinicians should be well aware of the psychiatric histories of patients to prevent them from developing serious adverse events related to LEV.

Specific adverse effects of antiepileptic drugs — A true-to-life monotherapy study

“…Levetiracetam was significantly associated with five AEs out of which three -anger/aggression, nervousness/agitation, and depression -were confirmative [20][21][22][23][24]. Sleep disturbances so far have been reported only occasionally [21,25] and probably are not in the focus of physicians' attention.…”

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

“…Recently, obsessive-compulsive disorder and behavioural changes associated with the use of levetiracetam have been reported [10][11][12][13]. 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].…”

Effects of Levetiracetam Monotherapy on the Cognitive Function of Epilepsy Patients

“…We included only drug-naïve epilepsy patients who were not exposed to any AEDs. In previous studies, LEV as an adjunctive treatment may reduce seizure frequency and improve cognitive function [12,15,17]. In those add-on studies, it was difficult to estimate the pure effect of LEV on cognition due to the concomitant use of other AED.…”