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

서지정보

· 발행기관 : 대한정신약물학회
· 수록지 정보 : 대한정신약물학회지 / 24권 / 2호 / 76 ~ 80페이지
· 저자명 : 김선영, 김재민, 김성완, 박철, 신일선, 정태영, 윤진상

초록

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.

영어초록

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.

참고자료

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