Review Article

Mechanisms Underlying Aggressive Behavior Induced by Antiepileptic Drugs: Focus on Topiramate, Levetiracetam, and Perampanel

Table 1

Frequencies of various psychiatric and behavioral adverse effects of levetiracetam, perampanel, and topiramate according to their European SPCs [2426].

Adverse effectComment

LevetiracetamCommon:
Depression, hostility/aggression, anxiety, insomnia, nervousness/irritability
Uncommon:
Suicide attempt, suicidal ideation, psychotic disorder, abnormal behavior, hallucination, anger, confusion, panic attack, affect lability/mood swings, agitation
Rare:
Completed suicide, personality disorder, thinking abnormal
Higher prevalence in children and adolescents than in adults: agitation (3.4%), mood swings (2.1%), affect lability (1.7%), aggression (8.2%), abnormal behavior (5.6%)

PerampanelCommon:
Aggression, anger, anxiety, confusion, irritability
Uncommon:
Suicidal ideation, suicide attempt
Aggression more frequently observed in adolescents than in adults

TopiramateVery common:
Depression
Common:
Irritability, bradyphrenia, insomnia, expressive language disorder, anxiety, confusion, disorientation, aggression, mood altered, agitation, mood swings, depressed mood, anger, abnormal behavior
Uncommon:
Suicidal ideation, suicide attempt, hallucination, psychotic disorder, hallucination auditory, hallucination visual, apathy, lack of spontaneous speech, sleep disorder, affect lability, libido decreased, restlessness, crying, dysphemia, euphoric mood, paranoia, perseveration, panic attack, tearfulness, reading disorder, initial insomnia, flat affect, thinking abnormal, loss of libido, listless, middle insomnia, distractibility, early morning awakening, panic reaction, elevated mood
Rare:
Mania, panic disorder, feeling of despair, hypomania
Irritability and expressive language among the most common adverse effects (>5%)
Higher prevalence in children than in adults (>2 times): suicidal ideation, abnormal behavior, aggression

Very common: ≥1/10, common: ≥1/100 to <1/10, uncommon: ≥1/1000 to <1/100, rare: <1/1000.