Background: Levetiracetam is a novel antiepileptic drug. It is marketed worldwide since 2000. Aim: The paper reviewed the mechanism of action, pharmacokinetics, adverse drug reactions, contraindications and uses of levetiracetam in the treatment of various types of epileptic seizures. Methods: Literature searches were done to identify relevant studies. Results: Levetiracetam acts by binding to the synaptic vesicle protein SV2A, thereby modulation of one or more of its actions and ultimately affecting neural excitability. It has less protein binding and lacks hepatic metabolism. In contrast to traditional therapy, it has a wide safety margin and does not require serum drug monitoring. It does not interact with other anti-epileptics. Conclusion: The above-mentioned favourable pharmacological benefits of LEV make it an important first-line or adjunctive therapy for epileptic seizures.

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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