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Factors associated with Psychiatric and Behavioral Adverse Events After Levetiracetam initiation in Psychiatric-Naïve Adults with Epilepsy: A Nested Case–Control Study |
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| รหัสดีโอไอ | |
| Creator | Waranya Usaha |
| Title | Factors associated with Psychiatric and Behavioral Adverse Events After Levetiracetam initiation in Psychiatric-Naïve Adults with Epilepsy: A Nested Case–Control Study |
| Contributor | Tinonkorn Yadee, Thitima Wattanavijitkul |
| Publisher | Faculty of Pharmaceutical Sciences KKU MSU UBU |
| Publication Year | 2569 |
| Journal Title | Isan Journal of Pharmaceutical Sciences |
| Journal Vol. | 22 |
| Journal No. | 2 |
| Page no. | 54-64 |
| Keyword | Antiseizure medication, Epilepsy, Levetiracetam, Psychiatric adverse events, Behavioral adverse events |
| URL Website | https://tci-thaijo.org/index.php/IJPS |
| Website title | Isan Journal of Pharmaceutical Sciences, IJPS |
| ISSN | 19050852 |
| Abstract | Levetiracetam is a widely used first-line antiseizure medication. However, psychiatric and behavioral adverse events (PBAEs) have been reported, whereas evidence regarding risk factors in patients without prior psychiatric disorders remains limited. Objective: To evaluate factors associated with PBAEs following levetiracetam initiation in outpatient adults with epilepsy without a history of psychiatric disorders. Methods: A nested case–control study was conducted among outpatient adults (aged ≥18 years) with epilepsy who initiated levetiracetam for the first time and had no prior psychiatric history. Cases and controls were matched by sex and age at a ratio of 1:3. Cases were patients who developed PBAEs within 12 months of levetiracetam initiation, whereas controls were selected from those who did not. Baseline characteristics were collected at the time of levetiracetam initiation. Dose-related data, including daily dose and dose escalation, were collected before the event date for cases and before the corresponding index date for matched controls. Conditional logistic regression was used for data analysis. Results: Among 356 eligible patients, 34 patients developed PBAEs and were matched with 102 controls, comprising a total of 136 patients included in the analysis. Irritability was the most common PBAE. The median time to onset was 2.9 months (IQR 0.8-6.0). Levetiracetam dose escalation of at least 500 mg/day was significantly associated with an increased risk of PBAEs (adjusted OR 4.50; 95% CI 1.46–13.92; p = 0.009). Conclusion: Levetiracetam dose escalation was associated with PBAEs in patients with epilepsy without prior psychiatric disorders. Careful dose titration and close monitoring for psychiatric symptoms during the first 3 months after treatment initiation may improve treatment safety and continuity. |
