Possible levetiracetam induced encephalopathy presenting as electrical status epilepticus: An unknown occurrence

Abstract

Levetiracetam is a novel, broad spectrum anti-epileptic drug with proven efficacy in generalized as well as focal onset seizures. It has renal elimination with no hepatic metabolism. Levetiracetam induced encephalopathy is rarely reported in literature. Triphasic waves in the electroencephalogram are seen in toxic-metabolic encephalopathies of various aetiology like hepatic encephalopathy, uraemia. We report a patient who was on levetiracetam for acute symptomatic seizures and developed encephalopathy with electroencephalogram showing generalised triphasic waves. These triphasic waves disappeared with intravenous lorazepam but without clinical improvement in sensorium. The electroencephalographic abnormality appeared as electrical status epilepticus which got normalised on discontinuation of levetiracetam. This is the first report of levetiracetam induced encephalopathy presenting as electrical status epilepticus and also depicts electroencephalographic correlate of levetiracetam induced encephalopathy.

Keywords

EEG - Electrical status epilepticus - Electroencephalography - Encephalopathy - Levetiracetam

• References

• 1 Specchio LM, Gambardella A, Giallonardo AT. et al. Open label, long-term, pragmatic study on levetiracetam in the treatment of juvenile myoclonic epilepsy. Epilepsy Res 71 2006; 32-39
• 2 Abou-Khalil B. Levetiracetam in the treatment of epilepsy. Neuropsychiatr Dis Treat 4 2008; 507-523
• 3 Cereghino JJ, Biton V, Abou-Khalil B, Dreifuss F, Gauer LJ, Leppik I. Levetiracetam for partial seizures: results of a double-blind, randomized clinical trial. Neurology 55 2000; 236-242
• 4 Bickford RG, Butt HR. Hepatic coma: the electroencephalograph pattern. J Clin Invest 34 1955; 790-799
• 5 Jallon P, Fankhauser L, Du Pasquier R. et al. Severe but reversible encephalopathy associated with cefepime. Neurophysiol Clin 30 2000; 383-386
• 6 Lynch BA, Lambeng N, Nocka K. et al. The synaptic vesicle protein SV2A is the binding site for the antiepileptic drug levetiracetam. Proc Natl Acad Sci U S A 101 2004; 9861-9866
• 7 Vulliemoz S, Iwanowski P, Landis T, Jallon P. Levetiracetam accumulation in renal failure causing myoclonic encephalopathy with triphasic waves. Seizure 18 2009; 376-378
• 8 Bauer J. Encephalopathy induced by levetiracetam added to valproate. Acta Neurol Scand 117 2008; 374-376
• 9 Verma R, Lalla R, Patil T. Levetiracetam induced encephalopathy in a patient with normal renal function: an unusual clinical encounter. Ann Indian Acad Neurol 16 2013; 727-729