Aggressive behavior of epilepsy patients in the course of levetiracetam add-on therapy: report of 33 mild to severe cases

Epilepsy Behav. 2003 Oct;4(5):537-47. doi: 10.1016/j.yebeh.2003.07.008.


Levetiracetam (LEV) was shown to be very efficacious and well tolerated as add-on therapy for refractory epilepsy. Here we report 33 patients with longstanding histories of epilepsy who experienced aggressive episodes during LEV therapy. This corresponds to 3.5% of LEV-treated patients as compared with less than 1% of patients not on LEV. Among these cases, 24 showed only moderate, partly transient irritability, with 10 patients requiring reduction or discontinuation of LEV. More strikingly, 9 patients displayed severe symptoms of aggression with physical violence and, in 2 cases, the need for psychiatric emergency treatment. One patient developed additional psychotic symptoms. We suggest that, specifically in patients with a previous history of aggression, behavioral tolerability of LEV should be carefully monitored.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Aggression / drug effects*
  • Anticonvulsants / adverse effects*
  • Anticonvulsants / therapeutic use
  • Drug Resistance
  • Drug Therapy, Combination
  • Epilepsy / complications
  • Epilepsy / drug therapy
  • Epilepsy / psychology*
  • Female
  • Humans
  • Irritable Mood / physiology
  • Levetiracetam
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Patient Compliance
  • Piracetam / adverse effects*
  • Piracetam / analogs & derivatives*
  • Piracetam / therapeutic use
  • Retrospective Studies


  • Anticonvulsants
  • Levetiracetam
  • Piracetam