{
  "abstract": "Background Levetiracetam is a commonly used first line anti-epileptic drug (AED) in the management of multiple types of epilepsy. Although efficacious in the prevention of epileptic seizures, commencement on levetiracetam has also been associated with a number of neuropsychiatric presentations including mood and behavioural changes, and psychosis. However, the long-term psychiatric outcomes associated with levetiracetam use in epilepsy are not well characterised. To understand this, we utilised a large real-world population database, to compare psychiatric outcomes in patients with epilepsy treated with levetiracetam compared to other commonly used psychotropic AEDs.Methods A retrospective analysis using the TriNetX network, consisting of anonymised health records of over 250 million patients across 19 countries, was undertaken. Patients aged 12 to 90 years, with a recorded ICD diagnosis of epilepsy, were divided into two cohorts- those prescribed levetiracetam versus those never prescribed either levetiracetam or brivaracetam, and prescribed carbamazepine, lamotrigine or valproate. Patients with a prior recorded ICD diagnosis of schizophrenia spectrum disorders, mental disorders caused by physical disease, bipolar disorder, or mania were excluded. Regularity of medication use was proxied by requiring included patients to be issued the first AED prescription within 6 months of epilepsy diagnosis, and at least 2 prescriptions of the medication across their record. Confounding risk factors were controlled through propensity score matching for age, sex, sociodemographics, clinical characteristics and medication use. Primary outcome was the incidence of and hazard ratios for psychiatric diagnoses from 6 months to 10 years after epilepsy diagnosis and first prescription of AED.Results 112336 patients were included in the analysis, 56168 in each AED cohort. Patients prescribed levetiracetam were not at higher risk of a new diagnosis of schizophrenia (HR 0.934 p=0.3737). Risk of new diagnosis of bipolar disorder was statistically significantly lower in patients prescribed levetiracetam (0.798 <0.0001).Conclusions Despite an increased risk of psychosis associated with levetiracetam use in the literature, in our analysis this did not translate to a higher long term incident risk of schizophrenia diagnosis. Our study also found that patients prescribed levetiracetam were less likely to be newly diagnosed with bipolar disorder, when compared against patients treated with other AEDs with established mood-stabilising effects. Further research is needed to elucidate whether levetiracetam could play a safe and efficacious role as a preventative medication for people at risk of bipolar disorder.",
  "authors": [
    {
      "affiliations": [
        "Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK"
      ],
      "name": "Katharine Lynch-Kelly"
    },
    {
      "affiliations": [
        "Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK"
      ],
      "name": "Danish Hafeez"
    },
    {
      "affiliations": [
        "Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK"
      ],
      "name": "Cameron J Watson"
    },
    {
      "affiliations": [
        "Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK"
      ],
      "name": "Thomas A Pollak"
    }
  ],
  "title": "#8212 Risk of incident psychotic and affective disorders associated with levetiracetam use in epilepsy",
  "uid": "5262153d-5a63-55c6-b011-486c5fd3e9e3"
}