Case Report Catatonia induced by levetiracetam Marie-Jose ´e Chouinard, Dang-Khoa Nguyen, Jean-Franc ¸ois Cle ´ment, Marie-Andre ´e Bruneau * Department of Psychiatry and Neurology, CHUM Ho ˆpital Notre Dame, 1560 rue Sherbrooke Est, Montre ´al (Que ´bec), Canada H2L 4M1 Received 26 December 2004; revised 15 April 2005; accepted 26 April 2005 Available online 24 October 2005 Abstract Levetiracetam (Keppra) is a novel antiepileptic drug approved as adjunctive treatment for adults with partial onset seizures. Although the drug is generally well tolerated, behavioral side effects have been reported in variable frequency. Most behavioral problems are mild in nature (agitation, hostility, anxiety, emotional lability, apathy, depression) and quickly resolve with discontin- uation of medication. However, serious psychiatric adverse events may also occur with rare cases of psychosis and suicidal behavior. We report here the case of a 43-year-old woman who developed symptoms compatible with catatonia after being exposed to leveti- racetam for the treatment of epilepsy. To our knowledge, it is the first reported case of catatonia induced by levetiracetam. We review the difficulties that may be encountered in the differential diagnosis of medical catatonia. Ó 2005 Published by Elsevier Inc. Keywords: Catatonia; Levetiracetam; Psychosis; Delirium 1. Introduction Levetiracetam (Keppra) was approved in November 1999 as add-on therapy for the treatment of partial on- set seizures in adults. The exact mechanism of action is unknown but presumed novel mechanisms include unique specific binding to a 90-kDa membrane protein restricted to neuronal cell types, suppression of inhibi- tion of GABA- and glycine-gated currents by zinc and b-carbolines, and partial inhibition of N-type voltage- gated calcium channels [1–4]. Central nervous system (CNS) adverse events include somnolence, asthenia, coordination difficulties, and behavioral abnormalities. In pivotal randomized controlled trials [5–7], 13.3% of levetiracetam-treated patients reported behavioral symptoms compared with 6.2% of placebo patients. Symptoms included agitation, hostility, anxiety, apathy, emotional lability, depersonalization, and depression. Although the majority of behavioral problems were mild or moderate in nature overall, a few patients reported psychotic symptoms (0.7% for levetiracetam vs 0.2% for placebo) or displayed suicidal behavior (0.5% for levetiracetam vs none for placebo) [8]. Subsequent long-term retrospective and prospective studies have suggested a higher prevalence of psychiatric adverse events [9–11]. Until now, catatonia has never been de- scribed in association with levetiracetam use. We now report on such a case. 2. The case Ms. J.R. is a 43-year-old, right-handed married woman referred to our epilepsy unit in March 2004 for presurgical workup linked to a refractory epilepsy. The patient was the product of a normal pregnancy, deliv- ered at term without complications. Although initial psychomotor development was within normal limits, she was soon found to be ‘‘slower’’ than other kids. She experienced learning difficulties in school, and even failed fifth grade. She finally managed to complete sixth 1525-5050/$ - see front matter Ó 2005 Published by Elsevier Inc. doi:10.1016/j.yebeh.2005.04.016 * Corresponding author. Fax: +1 514 412 7662. E-mail address: ma.bruneau@simpatico.ca (M.-A. Bruneau). www.elsevier.com/locate/yebeh Epilepsy & Behavior 8 (2006) 303–307