Levetiracetam accumulation in renal failure causing myoclonic encephalopathy with triphasic waves

Seizure. 2009 Jun;18(5):376-8. doi: 10.1016/j.seizure.2009.01.006. Epub 2009 Feb 7.


Triphasic waves are seen in the electro-encephalogram of adult patients with toxic-metabolic encephalopathies of various origins. Levetiracetam is a broad spectrum anti-epileptic drug with renal elimination and no hepatic metabolism. We describe the case of encephalopathy with triphasic waves concomitant with levetiracetam accumulation in a patient with chronic renal failure. The condition was reversible after down-titration of levetiracetam with no change of the renal function. Other causes of metabolic encephalopathy were excluded. Moreover, this patient suffered from a probable cortical myoclonus that relapsed after cessation of the drug but was well controlled by a low dosage adapted to the renal failure. In cases of metabolic encephalopathy with triphasic waves in a patient with renal failure taking levetiracetam, it is important to exclude toxic accumulation of levetiracetam among other causes.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • Anticonvulsants / adverse effects*
  • Electroencephalography / methods
  • Epilepsies, Myoclonic / chemically induced
  • Epilepsies, Myoclonic / etiology*
  • Epilepsies, Myoclonic / physiopathology*
  • Female
  • Humans
  • Levetiracetam
  • Piracetam / adverse effects
  • Piracetam / analogs & derivatives*
  • Renal Insufficiency / complications*
  • Renal Insufficiency / physiopathology*


  • Anticonvulsants
  • Levetiracetam
  • Piracetam