Visual hallucinations levetiracetam

A 5-year-old girl with refractory epilepsy treated with a ketogenic diet was given levetiracetam 250 mg bd (25 mg/kg/day). She had a history of mild mental retardation and was receiving special education. Two weeks later she started to have visual hallucinations, became agitated, bit relatives, and could not sleep. Levetiracetam was withdrawn and her symptoms resolved within 24 hours and did not recur. 

Levetiracetam and phenytoin have been retrospectively compared in the prophylaxis of early and late postoperative seizures in 315 patients [182 ]. Levetiracetam (n = 105) was at least as effective as phenytoin ( = 210) and significantly better tolerated. Adverse effects that prompted a change in antiepileptic drug therapy occurred in one patient taking levetiracetam, who had visual hallucinations, compared with 38 patients taking phenytoin (18%). In patients who were followed for at least 1 year and developed epilepsy, levetiracetam also had a higher retention rate. 

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