Abstract
BackgroundAntiepileptic drug (AED) induced dyskinesia is an unusual manifestation in the medical field. In the previous case reports describing first generation-AED related involuntary movements, the authors suggested that a plausible cause is pharmacokinetic interactions between two or more AEDs. To date, development of dyskinesia after levetiracetam (LEV) has not been reported.Case presentationA 28-year-old woman with a history of brain metastasis from spinal cord glioblastoma presented with several generalized tonic-clonic seizures without restored consciousness. LEV was administered intravenously. Thereafter no more clinical or electroencephalographic seizures were noted on video-EEG monitoring, while chorea movement was observed in her face and bilateral upper limbs.Discussion and conclusionsTo our knowledge, there is no case report of dyskinesia after administration of LEV. Considering the temporal relationship and absence of ictal video-EEG findings, we suggest that development of choreoathetosis was closely associated with the undesirable effects of LEV. We propose that dopaminergic system dysregulation and genetic susceptibility might underlie this unusual phenomenon after LEV treatment.
Highlights
Antiepileptic drug (AED) induced dyskinesia is an unusual manifestation in the medical field
Considering the temporal relationship and absence of ictal video-EEG findings, we suggest that development of choreoathetosis was closely associated with the undesirable effects of LEV
Levetiracetam (LEV) is a second-generation antiepileptic drug that is widely used for a variety of seizure types
Summary
We judged that the initial seizures were closely related to the patient’s brain lesion (right temporal lobe). A possibility remains that her symptom was a mesial temporal lobe seizure with oromandibular and manual automatisms because cessation of the movement was observed after administration of other AEDs. Most cases of anticonvulsant-induced chorea dyskinesia have been reported in association with first-generation AEDs [2]. It was experimentally shown that LEV has a role in stabilizing levodopa-induced dyskinesia in animals with MPTP-induced lesions [4] These findings demonstrated that LEV could affect the sensitivity of dopaminergic receptors. People carrying genetic variants associated with altered dopaminergic activity could be at high risk for chorea after LEV treatment. To our knowledge, this is the first report of dyskinesia after LEV treatment. As can be seen from our case, video-EEG monitoring is an important diagnostic method to ascertain if an abnormal movement originated from a true epileptic condition, and to evaluate and make a differential diagnosis among diverse movement phenomena which can be confusing when treating epilepsy patients
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