Enterocolitis: an adverse event in refractory epilepsy patients treated with levetiracetam?
BACKGROUND
Levetiracetam (LEV) is a recently marketed novel anti-epileptic drug with a promising efficacy and safety profile. In this report we describe two patients who presented with enterocolitis and discuss the possible relationship with concurrent LEV intake.


METHODS
In two patients. LEV was initiated to control refractory complex partial seizures (CPS). The first patient was treated with 1500 mg/day and complained of abdominal pain and weight loss 6 months later. Internal examination and colonoscopy revealed a punctate colitis. The second patient presented with bloody stool 1 month after LEV initiation. Colonoscopy showed punctate colitis. In both patients gastrointestinal symptoms disappeared following tapering of LEV.


CONCLUSIONS
There are no reports in the literature describing colitis related to LEV intake. Three possible mechanisms of action are discussed. Colitis may be part of a hypersensitivity syndrome caused by LEV. Pharmacodynamic interactions with other anti-epileptic drugs, for example, carbamazepine may play a role. A haematological adverse event is another possibility since piracetam, a related molecule, has a known impact on erythrocytes and platelets.


CONCLUSIONS
The close temporal relationship between initiation of LEV intake, symptomatic colitis and clinical improvement following LEV tapering, suggests that colitis may be a possible and previously undescribed adverse effect of LEV.
Bosman
Tommy
T
Department of Neurology, Reference Centre for Refractory Epilepsy, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium.
Vonck
Kristl
K
Claeys
Pieter
P
Van Vlierberghe
Hans
H
De Clercq
Matti
M
De Reuck
Jacques
J
Boon
Paul
P
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D004569:Electroencephalography; D004760:Enterocolitis / Q000139:chemically induced*; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D000077287:Levetiracetam; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010889:Piracetam / Q000009:adverse effects* / Q000031:analogs & derivatives
D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam