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Levetiracetam for Mood Stabilization and Maintenance of Seizure Control Following Multiple Treatment Failures

Clinical Associate Professor, School of Pharmacy, Division of Pharmacy Practice, University of Missouri at Kansas City, Kansas City, MO

Jessica W Lea, PharmD BCPP

Clinical Assistant Professor, School of Pharmacy, University of Missouri at Kansas City

Angel L Wolf

Psychiatric Pharmacy Practice Resident, Northwest Missouri Psychiatric Rehabilitation Center, Saint Joseph, MO

Arnaldo A Berges, MD

Staff Psychiatrist, Northwest Missouri Psychiatric Rehabilitation Center

Reprints: Dr. Stoner, Northwest Missouri Psychiatric Rehabilitation Center, 3505 Frederick Ave., St. Joseph, MO 64506-2914, fax 816/387-2391, stoners{at}umkc.edu

OBJECTIVE: To report the case of a patient who experienced adverse events in succession to antiepileptic medications being used for both antiepileptic and mood-stabilization benefit.

CASE SUMMARY: A 46-year-old white woman developed hyponatremia with carbamazepine, hyperammonemia with divalproex, cognitive impairment with topiramate, and hyponatremia with oxcarbazepine. The patient was stabilized physically and psychiatrically on levetiracetam without any noted adverse events.

DISCUSSION: The adverse events in this report have been associated with the medications in question. The patient's presentation is unique, as she developed adverse events in succession to antiepileptic drugs being used to treat both a seizure disorder and symptoms of mood instability. The Naranjo rankings for the reported adverse events indicated the associations were probable (carbamazepine, divalproex, oxcarbazepine) and possible (topiramate). After repeated incidences of intolerability to these drugs, levetiracetam was initiated and provided both seizure control and mood-stabilizing benefits, which eventually led to hospital discharge.

CONCLUSIONS: Levetiracetam may provide mood-stabilizing qualities through a mechanism that is unique from that of other antiepileptic agents used for their mood-stabilizing properties. There are potential advantages with levetiracetam, as no specific therapeutic drug monitoring parameters need to be followed after its introduction. Additionally, this case emphasizes the importance of therapeutic drug monitoring and frequent assessments to prevent physical and psychiatric adverse reactions.

Key Words: levetiracetam, mood, bipolar, schizoaffective

Published Online, October 4, 2005. www.theannals.com, DOI 10.1345/aph.1G320