Understanding Keppra (Levetiracetam)
Keppra, the brand name for levetiracetam, is a widely used second-generation anti-seizure medication (ASM) prescribed to manage various types of seizures in adults and children [1.3.6, 1.5.1]. It works by stabilizing abnormal electrical activity in the brain [1.5.1]. While effective for many—studies show 20% to 40% of users experience at least a 50% reduction in seizures—long-term use requires monitoring for potential side effects [1.8.3]. Most mild side effects, like drowsiness, may lessen over time as the body adapts [1.9.3]. However, some effects can persist or develop with prolonged use.
Neuropsychiatric and Behavioral Effects
The most significant long-term effects of Keppra are often behavioral and psychiatric. These can develop at any point during treatment and may be more common in children than adults [1.3.3].
Mood and Behavioral Changes
Non-psychotic behavioral symptoms are frequently reported. In clinical studies, these occurred in 13% of adult patients and up to 38% of pediatric patients aged 4 to 16 [1.4.1].
Commonly reported long-term behavioral and mood effects include:
- Irritability and Aggression: Sometimes referred to as "Keppra rage," this can manifest as agitation, hostility, and uncontrollable anger [1.4.1, 1.5.1].
- Mood Swings and Emotional Lability: Patients may experience rapidly changing moods or feel quick to react emotionally [1.4.1].
- Depression and Anxiety: Keppra can cause or worsen symptoms of depression and anxiety [1.4.3]. Like other antiepileptic drugs, it carries a risk of suicidal thoughts and behaviors, affecting approximately 1 in 200 to 1 in 530 people taking the medication [1.2.2, 1.5.1].
- Psychosis: Though less common, occurring in about 1% of patients, symptoms can include hallucinations and a loss of touch with reality [1.2.2, 1.4.5].
These behavioral side effects are a primary reason for dose reduction or discontinuation of the drug, particularly in pediatric patients [1.4.1]. Taking Vitamin B6 (pyridoxine) may help reduce some of these psychiatric side effects, though patients should consult their doctor for guidance [1.2.2, 1.4.2].
Cognitive Effects
The impact of long-term Keppra use on cognition is complex. While some studies suggest it is generally favorable compared to other ASMs, others indicate potential impairments, especially at high doses or in combination with other medications [1.3.5, 1.3.6].
- Memory and Concentration: Some patients report problems with memory and trouble concentrating [1.4.1].
- Drowsiness (Somnolence) and Fatigue: Somnolence is one of the most common side effects, reported in about 13-14% of users. This can impair the ability to drive or operate machinery [1.4.1, 1.8.5].
- Variable Study Results: One long-term study following patients on add-on Keppra therapy for a year found improvements in prospective memory and attention [1.3.2]. However, another study noted that high drug loads of Keppra are associated with cognitive impairment, particularly affecting language and verbal recall [1.3.5].
Physical Health Effects
Long-term use of anti-seizure medications can impact physical health, and Keppra is no exception.
Bone Health
While some older, enzyme-inducing AEDs are strongly linked to reduced bone mineral density, the data on Keppra is less definitive [1.6.4, 1.6.5]. Some preclinical studies in animals suggested decreased bone strength, but well-designed longitudinal studies in humans have suggested that Keppra monotherapy does not adversely affect bone health over a limited time [1.6.5, 1.6.6]. However, long-term use of AEDs in general is considered a risk factor for bone disease [1.6.2].
Kidney Function
Keppra is primarily cleared from the body by the kidneys [1.2.2]. For individuals with pre-existing kidney disease, the dosage often needs to be reduced to prevent the drug from accumulating and increasing the risk of side effects [1.2.5]. While rare, there have been post-marketing reports and a safety review by Health Canada that found a possible link between levetiracetam use and acute kidney injury [1.6.3].
Other Physical Effects
- Blood Cell Counts: Keppra can lead to decreases in white blood cell, neutrophil, and red blood cell counts, which can increase the risk of infection or cause fatigue [1.4.4].
- Coordination: Difficulties with coordination, unsteadiness, and dizziness are common side effects [1.2.1].
Comparison with Other Antiepileptic Drugs (AEDs)
When considering long-term treatment, it's helpful to compare Keppra's side effect profile to other common AEDs.
| Feature/Side Effect | Keppra (Levetiracetam) | Lamictal (Lamotrigine) | Topamax (Topiramate) |
|---|---|---|---|
| Primary Long-Term Concern | Behavioral/Mood changes (irritability, aggression) [1.4.1] | Serious skin rashes (Stevens-Johnson syndrome) | Cognitive impairment ("brain fog"), kidney stones [1.7.2, 1.7.4] |
| Cognitive Impact | Can impair learning/memory at high doses [1.7.1]. | Generally considered to have a more favorable cognitive profile [1.7.1, 1.7.3]. | Frequently associated with cognitive side effects [1.7.2, 1.7.3]. |
| Bone Health | Data is scarce, but appears less impactful than older AEDs [1.6.5]. | Appears not to induce accelerated bone loss [1.6.5]. | May cause metabolic acidosis, which can lead to osteoporosis [1.6.5]. |
| Patient Retention/Tolerance | Higher retention rate than Topamax [1.7.2]. User reviews show mixed experiences [1.7.5]. | Generally well-tolerated with high positive user ratings [1.7.5]. | Patients often discontinue due to neurocognitive side effects [1.7.2]. |
Managing Long-Term Effects
Open communication with a healthcare provider is key to managing long-term side effects. Strategies include:
- Dose Adjustment: A doctor may lower the dose to see if it alleviates symptoms like drowsiness or mood changes [1.9.1].
- Monitoring: Regular check-ups and blood tests can monitor for changes in kidney function and blood cell counts [1.4.4, 1.9.3].
- Lifestyle Adjustments: Avoiding alcohol is recommended as it can worsen side effects like drowsiness and dizziness [1.4.3].
- Do Not Stop Suddenly: Abruptly stopping Keppra can cause an increase in seizure frequency. Any discontinuation should be done gradually under a doctor's supervision [1.2.4].
Conclusion
Keppra is an effective medication for controlling seizures, but its long-term use is associated with a range of potential effects, most notably neuropsychiatric and behavioral changes like irritability, aggression, and mood swings, which are more pronounced in children [1.4.1]. While cognitive and physical health effects on bone and kidneys are also possible, they appear to be less common or definitive compared to some other AEDs [1.6.5, 1.7.2]. Patients should report any new or worsening symptoms to their healthcare provider to ensure the benefits of seizure control continue to outweigh the risks of long-term side effects.
For more information, you can visit the Epilepsy Foundation.
