Introduction

Levetiracetam is a second generation anti-epileptic drug with novel mechanism of action.¹ It is chemically unrelated to other antiepileptic drugs and is the α-ethyl analogue of the nootropic agent piracetam.¹ Its mechanism of action is unclear though it is postulated to bind to a presynaptic vesicle protein 2A (SV2A) that ultimately reduces the synaptic release of glutamate, impending conduction of epileptic action potentials across the synapse.² The United States Food and Drug Administration (FDA) approved levetiracetam in 1999 as an adjuvant antiepileptic medication for partial seizures in adults.³ Post marketing, open, uncontrolled clinical experience suggested potential benefit in patients with depressive symptoms with seizure disorder,  bipolar disorder and premenstrual dysphoric disorder.⁴

Levetiracetam is of proven efficacy in epileptic patients with brain tumours, and, as it is also used as intravenous formulation, it can be used as loading dose for seizure prophylaxis during and early after craniotomy.⁵ However, the category of behavioural symptoms including agitation, hostility, anxiety, apathy, emotional lability, depersonalization and depression was reported in 12.9% of patients on levetiracetam and psychotic symptoms was reported in 0.7% of patients.⁴

1. Kumar N, Swaroop HS, Chakraborty A, Chandran S. Levetiracetam induced acute reversible psychosis in a patient with uncontrollable seizures. Indian J Pharmacology. 2014; 46(5).560-1.
2. Park EM, Holmes JA, Reeder-Hayes KE. Acute mania associated with levetiracetam treatment. Psychosomatics. 2014; 55(1): 98-100.
3. Dannaram S, Borra D, Pulluri M, Jindal P, Sharma A. Levetiracetam induced acute psychotic episode. Innov Clin Neurosci.2012; 9(10):10-2.
4. Wang PW, Ketter TA. Anticonvulsants: Gabapentin, Topiramate, Tiagabine, Levetiracetam, Zonisamide and Pregabalin. In: Sadock BJ, Sadock VA, Ruiz P(eds.). Kaplan& Sadock’s Comprehensive Textbook of Psychiatry. 10^th New Delhi: Wolters Kluver; 2017. p.2974.
5. Chong JD, French JA. Levetiracetam. In: Shorvon S(ed.). The treatment of epilepsy. 4^th Singapore: John Wiley & Sons Ltd; 2016. 516-30.
6. Naranjo CA, Busto U, Sellers EM. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30: 239-45.
7. Kaur R. Non epileptic hallucinations with the use of levetiracetam. J Mental Health Human Beh. 2010; 15(1): 65-66.
8. Belcastro V, Pisani LR, Bellocchi S, Cairaghi P, Gorgone G, Mula M et al. Brain tumour location influences the onset of acute psychiatric events of levetiracetam therapy: an observational study. J Neurol. 2017; 264(5): 921-7.

Dr Reshmi Ramesan

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