title: Behavioral side-effects of levetiracetam in children with epilepsy: a systematic review.
abstract: OBJECTIVE
  Children with epilepsy are more likely to have behavioral problems compared to children without epilepsy. Literature suggests that levetiracetam leads to behavioral side-effects in children with epilepsy. The objective of this study is to provide a better overview of the frequency and variety of behavioral side-effects, which can be initiated by levetiracetam therapy in children with epilepsy.
  
  
  METHODS
  Electronic databases used in the search were PubMed, Medline, Cochrane and Embase. Studies were eligible for inclusion when they included children from one month to 18 years of age with a diagnosis of epilepsy, used levetiracetam, had other AEDs on a stable regimen for at least two months, reported about behavioral side-effects and had a follow-up of at least two weeks. Quality assessments and data collection were carried out for all eligible studies.
  
  
  RESULTS
  Thirteen studies, including 727 patients using levetiracetam, were included in this systematic review. Three randomized controlled trials showed a total of 62 behavioral side-effects in 203 patients, effects which led to discontinuation of levetiracetam in only two of 102 patients (2.0%). Hostility, nervousness and aggression were reported mostly. Meta-analysis showed a statistically significant relative risk of 2.18 for the total number of behavioral side-effects for levetiracetam versus placebo. Observational studies showed mixed results with both behavioral deteriorations and improvements following levetiracetam.
  
  
  CONCLUSIONS
  Based on the findings in this systematic review, children using levetiracetam have a risk of developing several behavioral side-effects such as aggression, hostility and nervousness compared to children who do not use levetiracetam.
authors: Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands. Electronic address: HalmaI@kempenhaeghe.nl.
authors: Elisabeth
authors: E
authors: Halma
authors: Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands. Electronic address: LouwA@kempenhaeghe.nl.
authors: Anton J A
authors: AJ
authors: de Louw
authors: Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: s.klinkenberg@mumc.nl.
authors: Sylvia
authors: S
authors: Klinkenberg
authors: Department of Behavioral Research and Clinical Neuropsychology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Faculty of Electrical Engineering, University of Technology, Eindhoven, The Netherlands; Department of Neurology, University Hospital Gent, Gent, Belgium. Electronic address: AldenkampB@kempenhaeghe.nl.
authors: Albert P
authors: AP
authors: Aldenkamp
authors: Department of Behavioral Research and Clinical Neuropsychology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands. Electronic address: IJffD@kempenhaeghe.nl.
authors: Dominique M
authors: DM
authors: IJff
authors: Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands. Electronic address: MajoieM@kempenhaeghe.nl.
authors: Marian
authors: M
authors: Majoie
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D002648:Child; D002653:Child Behavior Disorders / Q000139:chemically induced*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D004827:Epilepsy / Q000188:drug therapy*; D006801:Humans; D000077287:Levetiracetam; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam
keywords: Anti-epileptic drugs; Behavior; Behavioral problems; Children; Epilepsy; Levetiracetam