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Dr. Andrew Rynne

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What causes hallucinations while on Keppra?

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3601 Questions

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Posted on Tue, 21 Mar 2017 in Brain and Spine
Question: Mom has Alzheimer;s and Diabetes T-2 and recently received a pacemaker after surviving a heart attack. She was prescribed Keppra for seizures that no one can confirm she has had. Now she's screaming and hallucinating; at 85 years young our fears are that she'll have another attack from the stress she's experiencing and not sleeping for two days straight. Please advise: she's been on Keppra for more than a week; can this be stopped without causing more harm? She's suffering! Thanks!
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Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Can be stopped.

Detailed Answer:
I read your question carefully and I understand your concern.

While considered one of the safest antiseizure drugs Keppra can unfortunately cause behavior changes in a small percentage of patients. So it may well be this case.

Generally speaking it should be tapered gradually. However in your case you say it has been started only one week ago. Usually it is started by the lowest dose possible then raised gradually, so I believe the current dosage should be pretty low (you do not mention how much is she taking) and it shouldn't be a problem to interrupt it right away.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 11 hours later
Thanks you so much for your response. I was mistaken in saying how long she's been on Keppra. The hospital did have her on anti-seizure medication intravenously (amount unknown) before the 1 tablet of 500 mg of Keppra twice daily which she has been taking for a month. The screaming started about 2 1/2 weeks ago infrequently and has increased to almost nightly. The other medications that she is taking: Plavix 75 mg (1 daily), Atenolol 100 mg (1 nightly), Gabapentin 100 mg (1 daily), Namenda 10 mg (1 every 12 hrs; previously Namenda XR 28 mg once daily), Norvasc 5 mg (1 daily) and 81 mg aspirin 1 morning and 1 at night. We appreciate your advice and will also consult her physician. Thanks You!
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Answered by Dr. Olsi Taka 2 hours later
Brief Answer:
Read below.

Detailed Answer:
Thank you for the additional information.

Since it has been continued for longer than I thought then it shouldn't be interrupted right away. I would suggestto lower to 500 mg total daily dose for a couple of weeks (250 mg twice daily) and then interupting it altogether.
Hopefully that will help. You have to keep present that Keppra may not be the only cause. Advanced dementia may manifest hallucinations and other psychiatric symptoms as well. If due to Keppra though it should improve once Keppra is out of the picture.
Looking at the other medications I wonder how come she's not taking an acetylcholinesterase inhibitor along with Namanda (such as donepezil, rivastigmine, galantamine). Usually it is started with those, Namenda is added afterwards. But perhaps it has been tried and caused side effects, I am sure your physician considered those

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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