Levetiracetam-induced psychosis in a Filipino female diagnosed with anti-N-methyl-D-aspartate receptor encephalitis: a case report

Abstract

Levetiracetam (LEV), an SV2A inhibitor is a widely available anti-epileptic drug that is used to treat a range of partial and generalized seizure and juvenile myoclonic epilepsy. It is generally well tolerated and deemed safe due to the absence of drug-to-drug interaction. Despite its safety, there are adverse effects that can lead to the discontinuation of this anti-seizure medication. Some of the reported infrequent adverse effects are mood-related changes including agitation, depression, anxiety and suicidal ideations that can be observed after initiation or rapid up titration of the medication. The mechanism for this is still unknown but there are certain theories that attempted to determine the association. Risk factors reported were female sex, temporal lobe involvement and history of psychiatric disorder. In this case report, we present a 30-year-old female without history of psychiatric illness diagnosed with anti N-methyl-D-aspartate receptor (NMDAR) encephalitis who presented with seizure and was started on LEV for seizure control. She developed aggression and suicidal ideations secondary to initiation and up-titration of LEV. The symptoms resolved after discontinuation of the said medication.