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LEV Psychiatric Side Effects – Brivaracetam Switch — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersLEV Psychiatric Side Effects – Brivaracetam SwitchSCE Neurology

A 55-year-old man with epilepsy on levetiracetam develops significant irritability, agitation, and aggressive outbursts that are distressing to his family. He has no psychiatric history. His seizures are well controlled. What is the most likely cause and management?

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Correct answer: B — Levetiracetam-induced psychiatric adverse effects (irritability, agitation, aggression) — occurring in approximately 5–10% of patients; consider dose reduction or switching to brivaracetam (which has the same SV2A target but lower psychiatric side effect profile)

Levetiracetam commonly causes psychiatric adverse effects: irritability (~10%), agitation, aggressive behaviour, anxiety, depression, and rarely psychosis. These are dose-related and more common in patients with a prior psychiatric history (though they can occur de novo). Management: (1) dose reduction may improve symptoms while maintaining seizure control, (2) switching to brivaracetam (same SV2A target, higher affinity, fewer psychiatric side effects), (3) if continuing LEV, adding a low-dose SSRI or pyridoxine (B6 — anecdotal evidence) may help. A: Drug-induced, not personality change. C: This is a direct drug effect, not idiopathic depression. D: The temporal relationship to LEV initiation confirms the cause. E: No prior psychiatric history.

Reference: BNF – Levetiracetam; NICE NG217