One of the most commonly used antiepileptics these days is Levetiracetam (Keppra). There are many advantages to levetiracetam, including the ability to give large IV loading doses, equivalency between oral and IV dosing, and few drug-drug interactions. However, levetiracetam does have a dark side, so to speak – it can cause significant irritability and behavioral problems. This unfortunate side effect is sometimes called Keppra rage, and should not be taken lightly. In the clinic, patients and family members should be screened closely for increased irritability – patient’s and spouses may not know to bring this up on their own.

Levetiracetam is renally cleared, and needs to be dose adjusted for patients who are on dialysis. The fact that it does not alter hepatic metabolism makes it a good choice when giving an IV load to patients on warfarin, or who are actively using chemotherapeutic medications.

Francisco Goya’s Saturn Devouring his own Children, a sign, perhaps, that Keppra would not be the best anti-epileptic choice. This was part of Goya’s Black Series – which he painted directly on the walls of his home.

Another use of levetiracetam is treating myoclonic jerks, along with low doses of clonazepam or valproic acid.