Multifocal myoclonus as a presentation of levetiracetam toxicity

Mei Bou Nasif; Shweta Varade; Mohamad Z Koubeissi

doi:10.1016/j.cnp.2021.10.004

Multifocal myoclonus as a presentation of levetiracetam toxicity

Clin Neurophysiol Pract. 2021 Nov 7:6:281-284. doi: 10.1016/j.cnp.2021.10.004. eCollection 2021.

Authors

Mei Bou Nasif¹, Shweta Varade¹, Mohamad Z Koubeissi¹

Affiliation

¹ Department of Neurology, George-Washington University, Washington, DC, USA.

Abstract

Background: Levetiracetam (LEV) is widely used for treatment of focal and myoclonic seizures, but reports of LEV toxicity are scarce. Here, we report a rare case of multifocal myoclonus due to LEV toxicity in a patient with chronic renal insufficiency.

Case presentation: A 52-year-old woman with history of chronic kidney disease was admitted to the ICU for sedation and intubation after a cardiac arrest. She developed nonconvulsive status epilepticus that resolved after administration of propofol while receiving LEV 1500 mg twice a day. After holding the propofol infusion, the patient started having multifocal myoclonic jerks, documented on video-EEG recordings with a supratherapeutic level of LEV. After discontinuation of LEV, the myoclonus resolved.

Conclusion: This is a unique manifestation of LEV toxicity, which has been scarce in the literature. It suggests an inverted U-shaped dose-response of the antimyoclonic effect of LEV.

Keywords: Levetiracetam; Multifocal myoclonus; Pharmacology.

Publication types

Case Reports