levetiracetam and Catatonia

An 82-year-old man was admitted to the emergency department following bizarre behaviour. Police had noticed him driving erratically through his village. He did not stop when instructed, drove slowly home and appeared 'vacant' on questioning. While in hospital, he had approximately 15 episodes of catatonia, involving rigidity, negativism, mutism except echolalia and perseveration, automatic obedience and utilisation phenomena, lasting 2-20 min each. Between episodes, he was amnestic but otherwise well. Electroencephalography demonstrated bifrontal slowing with left-sided emphasis, and captured two focal onset partial seizures with the clinical correlate of the syndrome described above. He improved rapidly on levetiracetam and lorazepam, was discharged and received a diagnosis of dementia by his community mental health team shortly afterwards, based on chronic short-term memory loss, functional decline and MRI changes. This case has implications for our understanding of the neural correlate of catatonia, specifically frontal lobe pathway dysfunction.

Topics: Aged, 80 and over; Anticonvulsants; Automatism; Catatonia; Dementia; Diagnosis, Differential; Electroencephalography; Epilepsy, Frontal Lobe; Humans; Levetiracetam; Lorazepam; Magnetic Resonance Imaging; Male; Piracetam

Topics: Adult; Anticonvulsants; Catatonia; Epilepsy, Temporal Lobe; Humans; Levetiracetam; Lorazepam; Male; Neurosurgical Procedures; Piracetam; Temporal Lobe; Treatment Outcome

Levetiracetam (Keppra) is a novel antiepileptic drug approved as adjunctive treatment for adults with partial onset seizures. Although the drug is generally well tolerated, behavioral side effects have been reported in variable frequency. Most behavioral problems are mild in nature (agitation, hostility, anxiety, emotional lability, apathy, depression) and quickly resolve with discontinuation of medication. However, serious psychiatric adverse events may also occur with rare cases of psychosis and suicidal behavior. We report here the case of a 43-year-old woman who developed symptoms compatible with catatonia after being exposed to levetiracetam for the treatment of epilepsy. To our knowledge, it is the first reported case of catatonia induced by levetiracetam. We review the difficulties that may be encountered in the differential diagnosis of medical catatonia.

Topics: Adult; Anticonvulsants; Antipsychotic Agents; Catatonia; Drug Therapy, Combination; Epilepsies, Partial; Female; Humans; Levetiracetam; Paranoid Disorders; Piracetam; Risperidone