From the Guidelines
Symptoms are subjective experiences reported by patients, including physical and emotional sensations, such as pain, dyspnea, anorexia, nausea, vomiting, constipation, fatigue, weakness, asthenia, insomnia, daytime sedation, and delirium, as well as other experiences like thirst, anxiety, and sleep disturbances. These symptoms can be assessed using validated instruments and should be evaluated routinely, at regular intervals, and documented, as recommended by the European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit 1. The assessment of symptoms should include the presence of each symptom, its severity, and any exacerbating and relieving factors, and should continue after interventions. Common symptoms that must be assessed include:
- Pain
- Dyspnea
- Anorexia
- Nausea
- Vomiting
- Constipation
- Fatigue
- Weakness
- Asthenia
- Insomnia
- Daytime sedation
- Delirium
- Thirst
- Anxiety
- Sleep disturbances
According to the most recent and highest quality study, symptom assessment should be performed routinely, at regular intervals, and documented, using validated instruments to evaluate the presence, severity, and exacerbating and relieving factors of each symptom 1. This approach is crucial for providing high-quality patient care, particularly in palliative care settings, where symptom management is a key aspect of improving patients' quality of life, as highlighted in the Journal of the National Comprehensive Cancer Network 1. Additionally, symptoms can also be associated with other medical conditions, such as acute sinusitis, which typically presents with symptoms like nasal congestion, purulent rhinorrhea, postnasal drainage, facial or dental pain, headache, and cough, as described in the Journal of Allergy and Clinical Immunology 1.
From the FDA Drug Label
In controlled trials of patients with epilepsy experiencing partial onset seizures, 5 (0. 7%) of levetiracetam-treated patients experienced psychotic symptoms compared to 1 (0.2%) placebo patient. A total of 13.3% of levetiracetam patients experienced other behavioral symptoms (reported as aggression, agitation, anger, anxiety, apathy, depersonalization, depression, emotional lability, hostility, irritability, etc.) compared to 6. 2% of placebo patients. A total of 37. 6% of the levetiracetam-treated patients experienced behavioral symptoms (reported as agitation, anxiety, apathy, depersonalization, depression, emotional lability, hostility, hyperkinesia, nervousness, neurosis, and personality disorder), compared to 18.6% of placebo patients. Non-psychotic behavioral disorders (reported as aggression and irritability) occurred in 5% of the levetiracetam-treated patients compared to 0% of placebo patients. Non-psychotic mood disorders (reported as depressed mood, depression, and mood swings) occurred in 6. 7% of levetiracetam-treated patients compared to 3.3% of placebo patients.
Symptoms associated with levetiracetam treatment include:
- Psychotic symptoms: hallucinations, psychosis
- Behavioral symptoms:
- Aggression
- Agitation
- Anger
- Anxiety
- Apathy
- Depersonalization
- Depression
- Emotional lability
- Hostility
- Hyperkinesia
- Irritability
- Nervousness
- Neurosis
- Personality disorder
- Mood disorders: depressed mood, depression, mood swings
- Somnolence and fatigue
- Coordination difficulties: ataxia, abnormal gait, incoordination 2 2
From the Research
Definition of Symptoms
Symptoms are not directly defined in the provided studies. However, the studies discuss various conditions, such as epilepsy, and their associated symptoms.
Symptoms of Epilepsy
- Seizures, including partial-onset seizures, primary generalized tonic-clonic seizures, and myoclonic seizures 3
- Somnolence, asthenia, infection, and dizziness as adverse effects of levetiracetam in adults 3
- Hostility and nervousness as behavioral adverse effects of levetiracetam in children 3
- Seizure events, including first seizure events, in patients with intracerebral hemorrhage, traumatic brain injury, supratentorial neurosurgery, and spontaneous subarachnoid hemorrhage 4
Diagnostic Tools for Epilepsy
- MRI and EEG are highly sensitive methods in the diagnosis and localization of epileptogenic focus 5
- CT scan is also used in the diagnosis of epilepsy, but it has lower sensitivity compared to MRI 5, 6
- Diffusion-weighted images are useful for detecting early changes in the brain associated with seizures 6
Epileptogenic Focus
- Hippocampal sclerosis is a common finding in patients with refractory epilepsy, and it is associated with a high risk of developing refractory epilepsy 5
- Cerebral malformations, such as holoprosencephaly, hemimegalencephaly, and lissencephaly, can cause epilepsy and seizures 6
- Neurocutaneous syndromes, such as tuberous sclerosis and Sturge-Weber syndrome, can also cause epilepsy and seizures 6