Coma after levetiracetam overdose

Levetiracetam is an anticonvulsant prescribed for partial seizures and as an adjunct in the treatment of generalised tonic-clonic seizures. Adverse effects are relatively mild in comparison with older anticonvulsants. We present the case of a 50-year-old patient who ingested over 20,000 mg of levetiracetam in a suicide attempt. When she arrived at the emergency department nine hours after ingestion she was comatose and required intubation and ventilatory support for 24 hours. Thirty-six hours after admission she had completely recovered. Although the recent literature reports mostly mild symptoms even with very high ingested doses, this case shows that potentially life-threatening side effects can occur with lower doses than previously described and that psychiatric side effects are important. Moreover this case showed that life-threatening symptoms do not require high blood levels.