Dhungel Omkar, Shrestha Amit, Pathak Pankaj, Sharma Pawan
Patan Academy of Health Sciences, School of Medicine, Department of Psychiatry, Lalitpur, Nepal.
Case Rep Psychiatry. 2023 Sep 15;2023:5575900. doi: 10.1155/2023/5575900. eCollection 2023.
Levetiracetam (LEV), a second-generation antiepileptic, is used as an adjunct therapy in primary generalized tonic-clonic seizures, refractory partial-onset seizures, and seizure prophylaxis after brain surgery. It is well tolerated, effective and has a convenient dosing regimen. As any other drugs, it has some adverse drug effects, including neuropsychiatric adverse effects ranging from agitation and mood symptoms to psychosis and suicide. Strong diagnostics guidelines are yet to be formulated for LEV-induced psychosis; however, complete recovery from psychotic symptoms after stopping LEV supports the possible adverse reaction from Naranjo's algorithm and, hence, the diagnosis. This case report presents a 16 years boy with focal onset generalized tonic-clonic seizure, whose drug regimen was switched to LEV, following which he had the delusion of persecution, second-person auditory hallucination, and aggressive behavior, which decreased on the 2nd day of cessation of LEV.
左乙拉西坦(LEV)是一种第二代抗癫痫药物,用作原发性全面强直阵挛性发作、难治性部分性发作以及脑手术后癫痫预防的辅助治疗。它耐受性良好、疗效显著且给药方案便捷。与其他任何药物一样,它也有一些药物不良反应,包括从激动和情绪症状到精神病和自杀等神经精神方面的不良反应。针对左乙拉西坦所致精神病,尚未制定强有力的诊断指南;然而,停用左乙拉西坦后精神病症状完全恢复,这支持了根据纳朗霍算法得出的可能不良反应,从而支持该诊断。本病例报告介绍了一名16岁患有局灶性发作全面强直阵挛性癫痫的男孩,其药物治疗方案换用左乙拉西坦后,出现了被害妄想、第二人称幻听和攻击行为,在停用左乙拉西坦的第二天这些症状有所减轻。