Reactions 1933, p262 - 19 Nov 2022 1

Levetiracetam S

Aggravation of low mood : case report

A 43-year-old man developed aggravation of low mood during treatment with levetiracetam for brain tumour-related epilepsy.
The right-handed man had been diagnosed with chiasmatic pilocytic astrocytoma for which he underwent debulking and
craniotomy followed by stereotactic radiosurgery (SRS). After 9 years, he presented with regular focal seizures. Imaging confirmed
the diagnosis of right mesial temporal and right orbitofrontal regions gliosis secondary to surgery and SRS. He was diagnosed brain
tumour-related epilepsy and responded well to carbamazepine. After 4 months, he was hospitalised after frequent seizures
including bilaterally convulsive attacks, generalised headache and abdominal discomfort. A levetiracetam [dosage and route not
stated] was added to his regimen. He was commenced on unspecified antidepressants [antidepressant]. Initially, his symptoms
settled, but worsened weeks later leading to readmission. He experienced lower limb twitching attacks evolving into generalised
limb movements. An EEG ambulatory captured multiple attacks which was not associated with ictal change and interictal EEG was
unremarkable. No focal seizures were captured during 72h recording. Based on these, a diagnosis of NEAD was made.
Concomitantly, he had low mood, which was aggravated by levetiracetam. He admitted that the fear of seizure recurrence could
have led to NEAD [duration of treatment to reaction onset not stated].
The man’s levetiracetam was gradually discontinued [outcome not stated]. His nonepileptic events decreased in frequency and
his acceptance of NEAD and the potential triggers contributed to his recovery.
Sumangala S, et al. Nonepileptic attacks in patients with brain tumor-related epilepsy. Epilepsy and Behavior 129: 108656, Apr 2022. Available from: URL: http://
doi.org/10.1016/j.yebeh.2022.108656 803728708

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