A client with epilepsy controlled on levetiracetam (Keppra) for two years reports to the nurse that they have been feeling increasingly irritable, anxious, and having angry outbursts that are affecting their family relationships. The client asks if this could be related to the medication. Which response by the nurse is most accurate?
Correct! Levetiracetam has a well-documented psychiatric side effect profile sometimes called "Keppra rage." Behavioral adverse effects occur in up to 25% of clients and include: irritability, agitation, aggression, anxiety, and depression. These side effects can significantly impair quality of life and are a major reason clients discontinue the medication. The neurologist should be informed — options include: dose reduction, addition of vitamin B6 (pyridoxine — some evidence for reducing behavioral side effects), or switching to a different antiepileptic. The client should never abruptly discontinue antiepileptics.
Clinical pearl: Clinical Pearl: Antiepileptic drug psychiatric side effect profiles: LEVETIRACETAM — irritability, aggression, depression (up to 25%). TOPIRAMATE (Topamax) — cognitive slowing ("Dopamax"), depression, word-finding difficulties, kidney stones. VALPROIC ACID — sedation, weight gain, tremor. PHENYTOIN — sedation, nystagmus, ataxia, gingival hyperplasia. LAMOTRIGINE — generally positive mood effects, life-threatening rash (Stevens-Johnson Syndrome — rare, especially with rapid titration or valproic acid co-administration). GABAPENTIN — sedation, peripheral edema, weight gain. The choice of antiepileptic must balance efficacy with the client's individual side effect profile.