LEV is a second generation AED with side effects including mood dysfunction, irritability, and fatigue. The risk of side effects is quoted near 20%, but in the EMU, these side effects are reported frequently, resulting in transition to alternative agents.

A retrospective chart review was conducted searching for patients aged 16-99 years admitted to Mayo Clinic Arizona over the last 8 years (2011-2019). Patients admitted to the EMU on maintenance LEV were included. Patients were excluded for:  diagnosis of non-epileptic spells, admission for intracranial monitoring, and admission from an outside facility for ictal SPECT scan.

Two-hundred and ten admissions were identified. The average total daily dose of LEV was 2,194.5mg (range, 500-5500mg). The majority 106/210 (50.5%) reported at least one side effect described as irritability 33/210 (15.7%), unspecified mood disturbance 35/210 (15.2%), anxiety 13/210 (6.2%), depression 17/210 (8.1%), fatigue 11/210 (5.2%), or suicidal ideation 5/210 (2.4%). Overall, the rate of at least one behavior side effect was 46.7%. While admitted, 74/106 (69.8%) were initiated on a new AED. Of those 74, at time of discharge, instructions were to wean or discontinue LEV in 58/74 (78.4%). The AEDs most commonly initiated prior to discharge were lamotrigine in 32/74 (43.2%), lacosamide in 11/74 (14.9%), zonisamide in 8/74 (10.8%), and clobazam in 8/74 (10.8%).

At the time of EMU admission, side effects from LEV were reported in 50.5% of patients. LEV was transitioned mostly commonly to lamotrigine (43.2%) in our population. We recommend counseling patients regarding behavioral side effects and prompt follow-up when side effects are noted. When necessary, transition to an AED with a lower incidence of adverse mood effects should be considered.