Is Levetiracetam (antiepileptic drug) effective for treating autism?

Levetiracetam for Autism Spectrum Disorder

Levetiracetam is not effective for treating autism spectrum disorder itself, but may be beneficial in a specific subset of autism patients who have subclinical epileptiform discharges (SEDs) on EEG. 1

Evidence for Levetiracetam in Autism

• Levetiracetam is primarily an antiepileptic drug (AED) approved for seizure disorders, not specifically for autism 2
• A 2017 randomized controlled trial showed that levetiracetam combined with educational training improved behavioral and cognitive functions in children with autism who had subclinical epileptiform discharges (SEDs) compared to educational training alone 1
• The study demonstrated improved scores on standardized autism assessment tools (PEP-3, CARS, ABC) and higher rates of EEG normalization in the levetiracetam treatment group 1
• Current evidence does not support the use of levetiracetam for treating core autism symptoms in patients without SEDs 2

Important Considerations and Adverse Effects

• Behavioral adverse effects are a significant concern with levetiracetam use in autism patients:
  • Case reports document levetiracetam-induced reversible autistic regression in some children 3
  • Irritability and hyperactivity/impulsivity occur more frequently in patients with comorbid autism or ADHD 4
  • Acute psychosis has been reported in children taking levetiracetam, with symptoms including hallucinations and agitation 5
• These behavioral side effects appear more common in children and those with pre-existing neurobehavioral problems 5

Clinical Approach for Levetiracetam Use in Autism

• Consider levetiracetam only in autism patients with:
  • Documented seizures requiring treatment 6
  • Confirmed subclinical epileptiform discharges on EEG 1
• Recommended dosing if used:
  • For seizures: 30 mg/kg IV at a rate of 5 mg/kg per minute 7
  • Careful dose titration is essential to minimize behavioral side effects 5
• Monitor closely for:
  • Behavioral changes, especially irritability, aggression, or psychosis 5, 4
  • EEG changes in patients with subclinical epileptiform discharges 1
  • Cognitive and behavioral function using standardized assessments 1

Summary of Current Evidence

• Levetiracetam should not be used as a primary treatment for autism spectrum disorder 2
• It may be considered in the specific subgroup of autism patients who have:
  • Confirmed seizure disorders requiring treatment 6
  • Documented subclinical epileptiform discharges on EEG 1
• The benefit-risk ratio must be carefully evaluated for each individual patient, with close monitoring for behavioral adverse effects 2, 5, 4
• More research from larger trials is needed before levetiracetam can be recommended for non-epileptic manifestations of autism 2