Session Title: AA 2021 Virtual Posters - Neurological Rehabilitation
Session Time: None. Available on demand.
Disclosures: Ramza S. Malik, DO: No financial relationships or conflicts of interest
Case Diagnosis: A patient developed mutism while being treated with levetiracetam for seizure prophylaxis.
Case Description: A functionally active and independent 85-year-old female with a history of Parkinson’s Disease presented after a fall with loss of consciousness having sustained a right subdural hematoma (SDH), small subarachnoid hemorrhages, and a right femoral neck fracture. Her SDH was managed non-operatively and she was started on levetiracetam 750mg BID for seizure prophylaxis. Her chronic home medications including carbidopa/levodopa and entacapone were continued. During her post-operative course, she was intermittently encephalopathic. Her metabolic and infectious work-up was unremarkable. Her electroencephalogram (EEG) showed bilateral parietal sharp waves without epileptiform activity. During her course in inpatient rehabilitation, she demonstrated intermittent agitation, aggression, confusion, and mutism. Her serum levetiracetam levels were within the therapeutic range. Repeat EEGs were unremarkable for seizure activity and subsequent brain imaging studies indicated improving condition of her SDH. Through Neurology consultation, she was diagnosed with levetiracetam-induced mutism. Once the levetiracetam was discontinued, her symptoms gradually resolved. Prior to discharge, the patient was able to ambulate independently with equipment, required minimal assistance for some activities of daily living, and regained her baseline speech.
Setting: Community Hospital Inpatient Rehabilitation FacilityAssessment/
Results: A patient with reduced neurologic reserve due to age and underlying Parkinson’s disease developed mutism in addition to the other more commonly known side effects of levetiracetam.
Discussion: Generally, levetiracetam is a well-tolerated anti-epileptic. Its off-label use includes seizure prophylaxis for patients with cumulative risk factors. Common adverse effects include aggression, anxiety, and depression. Uncommon effects are psychosis, hallucinations, confusion, and agitation. We report mutism as an unusual adverse effect of levetiracetam. Importantly, she was at an increased risk due to her advanced age, age-inappropriate dosing of levetiracetam, history of Parkinson’s, and use of entacapone.
Conclusion: Mutism is a rare but possible adverse effect of levetiracetam use.
Level of Evidence: Level V
To cite this abstract in AMA style:Malik RS, Nitu-Marquise A, Turk M. Mutism as an Unusual Reaction to Levetiracetam: A Case Report [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/mutism-as-an-unusual-reaction-to-levetiracetam-a-case-report/. Accessed September 24, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/mutism-as-an-unusual-reaction-to-levetiracetam-a-case-report/