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Levetiracetam – Psychiatric Side Effects — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersLevetiracetam – Psychiatric Side EffectsSCE Neurology

A 65-year-old woman on levetiracetam for focal epilepsy develops persistent irritability, agitation, and low mood 6 weeks after starting the medication. What is the most appropriate management?

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Correct answer: B — Switch to an alternative antiseizure medication such as lamotrigine

Psychiatric adverse effects (irritability, agitation, depression, behavioural change) are well-recognised side effects of levetiracetam, occurring in approximately 10–15% of patients. If these are persistent and troublesome, switching to an alternative medication (such as lamotrigine for focal epilepsy) is appropriate. A: Adding an SSRI addresses symptoms but not the cause. B: Increasing the dose would likely worsen psychiatric effects. D: Stopping without replacement risks seizure recurrence. E: Benzodiazepines are not appropriate long-term management.

Reference: NICE NG217 (2025); BNF – Levetiracetam