Levetiracetam Induced Acute Suicidal Ideations in a Patient of Juvenile Myoclonic Epilepsy

Abstract

The US Food and Drug Administration (FDA) approved levetiracetam as an antiepileptic drug (AED) in 1999. After nine years, the FDA released a postmarketing statement describing an increased risk of suicide (0.43%) in patients taking AEDs, including levetiracetam.1 Levetiracetam is a second-generation AED that has shown clinical effectiveness in generalized and partial epilepsy syndromes as monotherapy and adjunctive treatment.2 The recommended starting dose of levetiracetam is 500 mg twice daily and it can be titrated by 1,000 mg every 2 weeks as needed to a maximum dose of 3,000 mg daily.3 The most common side effect of levetiracetam was found to be sedation at 10.7%, while mood disturbance was found in 4.8% of patients.4 A possible association has been reported between the use of levetiracetam and suicidality.5 We here describe the case of a patient with a history of juvenile myoclonic epilepsy without any family history or past history of psychiatric illness being treated with levetiracetam, who developed acute onset of suicidal ideations when the dose of levetiracetam was increased, which subsided in a span of five days when levetiracetam was gradually stopped and sodium valproate was introduced. To the best of our knowledge, this is one of the very few case reports from India that demonstrates the temporal association of levetiracetam with acute onset of suicidal ideations in the absence of other risk factors for AED-induced suicidal behavior.