Levetiracetam accumulation in renal failure causing myoclonic encephalopathy with triphasic waves.
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.
Vulliemoz
Serge
S
EEG and Epilepsy Unit, University Hospital and Faculty of Medicine of Geneva, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. serge.vulliemoz@hcuge.ch
Iwanowski
Patricia
P
Landis
Theodor
T
Jallon
Pierre
P
D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000009:adverse effects*; D004569:Electroencephalography / Q000379:methods; D004831:Epilepsies, Myoclonic / Q000139:chemically induced / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives*; D051437:Renal Insufficiency / Q000150:complications* / Q000503:physiopathology*
D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam