Levetiracetam 사용 후 발생한 공격성의 증가 1예 = A Case Report on Increased Aggression after Treatment with Levetiracetam

다국어 초록 (Multilingual Abstract)

Levetiracetam is a new antiepileptic drug that is used widely in Korea. It has reported behavioral side effects, most notably irritability, agitation, and aggressive behavior. However, these behavioral side effects are often not considered by prescribers and psychiatrists. We report a 64-year-old male with a cerebral astrocytoma who was referred to the department of psychiatry for increased aggression and irritability. The severity of symptoms did not fluctuate over a 24-hour period, and there was no evidence of depression (Clinical Global Impression of depression severity score: 2). The scores of scales for delirium and cognitive function did not support the possible diagnosis of delirium or dementia [Korean Mini-Mental State Examination (K-MMSE): 25; Korean version of the Delirium Rating Scale-Revised-98: 5]. The severity of aggression was very high in the trait questions of the Korean adaptation of the State-Trait Anger Expression Inventory (STAXI-K: 34). After ruling out dementia, delirium, depression, and an organic mental disorder, we thought that the aggression and irritability might be related to levetiracetam, and recommended discontinuing it without treating the symptoms. After discontinuing the levetiracetam, the patient and caregiver reported a dramatic improvement in the aggression and irritability within 3 days, and the score on the STAXI-K decreased to 10. Twenty-eight weeks follow up after consultation, the STAXI-K was 10, and K-MMSE was increased to 26. We considered a final diagnosis of other substance (levetiracetam)-related disorder not otherwise specified because of the temporal relationship between the use of levetiracetam, occurrence of the symptoms, and improvement on withdrawing the drug. The behavioral side effects of levetiracetam should be considered, especially in patients who develop behavioral changes while taking the drug.

국문 초록 (Abstract)

levetiracetam은 국내외에서 흔히 사용되는 항경련제이며,사용시 정신행동부작용이 높은 빈도로 보고되지만 국내에서이에 대한 보고는 많지 않다. 저자들은 levetiracetam 사용 후증가된 공격성 등 성격변화가 levetiracetam 중단 후 호전된증례를 국내에서는 최초로 보고하였다. 본 증례를 통해 처방의사는 levetiracetam의 정신행동부작용에 관심을 기울여야하는 한편, 정신건강의학과 의사는 levetiracetam 사용 중인환자에서 공격성, 자극 과민성 등을 주소로 하는 협의 진료시 반드시 약물 관련성 등을 평가해야 함을 제시하였다.

참고문헌 (Reference)

• 1 임경옥, "한국판 섬망 평가 척도-98(K-DRS-98)의 표준화 연구" 대한신경정신의학회 45 (45): 518-526, 2006
• 2 김성완, "일 대학병원에서 5년간 시행된 정신과 자문의뢰 분석" 한국정신신체의학회 19 (19): 28-33, 2011
• 3 이건수, "난치성 소아 간질에서 levetiracetam의 효과" 대한소아과학회 53 (53): 571-578, 2010
• 4 Varghese BS, "Topiramate for anger control: a systematic review" 42 : 135-141, 2010
• 5 Lynch BA, "The synaptic vesicle protein SV2A is the binding site for the antiepileptic drug levetiracetam" 101 : 9861-9866, 2004
• 6 Akechi T, "Psychiatric disorders in cancer patients: descriptive analysis of 1721 psychiatric referrals at two Japanese cancer center hospitals" 31 : 188-194, 2001
• 7 Kenna HA, "Psychiatric complications of treatment with corticosteroids: review with case report" 65 : 549-560, 2011
• 8 Helmstaedter C, "Positive and negative psychotropic effects of levetiracetam" 13 : 535-541, 2008
• 9 Ahles TA, "Neuropsychological Impact of Cancer and Cancer Treatments, In Psycho-Oncology" Oxford 251-257, 2010
• 10 Bootsma HP, "Long-term effects of levetiracetam and topiramate in clinical practice: A head-to-head comparison" 17 : 19-26, 2008
• 11 Berkovic SF, "Levetiracetam N01057 Study Group. Placebo-controlled study of levetiracetam in idiopathic generalized epilepsy" 69 : 1751-1760, 2007
• 12 Chon KK, "Korean adaptation of the State-Trait Anger Expression Inventory (STAXI-K): the case of college students" 3 : 18-32, 1998
• 13 IMS Health Analysis, "IMS MIDAS Quantum, MAT 3Q"
• 14 Beran RG, "Efficacy and safety of levetiracetam 1000-3000 mg/day in patients with refractory partial-onset seizures: a multicenter, openlabel single-arm study" 63 : 1-9, 2005
• 15 Guy W, "ECDEU Assessment Manual for Psychopharmacology" US Department of Health, Education and Welfare, NIMH 218-222, 1976
• 16 "Drug information"
• 17 "Drug information"
• 18 Abou-Khalil B, "Benefit-risk assessment of levetiracetam in the treatment of partial seizures" 28 : 871-890, 2005
• 19 Teasdale G, "Assessment of coma and impaired consciousness. A practical scale" 2 : 81-84, 1974
• 20 Edwards IR, "Adverse drug reactions: definitions, diagnosis, and management" 356 : 1255-1259, 2000
• 21 Kang Y, "A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients" 15 : 300-308, 1997
• 22 Naranjo CA, "A method for estimating the probability of adverse drug reactions" 30 : 239-245, 1981