# Parents of a 10-year-old child on levetiracetam for new-onset epilepsy report new irritability, aggression, and emotional outbursts since starting therapy. Which is the nurse's best response?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391750&lang=en  
> language: en  
> subject: Crisis Intervention  
> category: PSI

## Question

Parents of a 10-year-old child on levetiracetam for new-onset epilepsy report new irritability, aggression, and emotional outbursts since starting therapy. Which is the nurse's best response?

## Option

1. "Levetiracetam can cause irritability and behavioral changes; notify the prescriber — pyridoxine (B6) supplementation or a medication change may be considered." **✔ Correct answer**
2. "These behavioral changes can occur but are usually mild and temporary; continue the medication and keep a diary of the behaviors."
3. "These behaviors are likely due to the underlying epilepsy; adjusting the medication could worsen seizures, so we should not change anything at this point."
4. "These symptoms are not typically associated with levetiracetam; you should discuss a referral for psychological assessment with the provider."

**Correct answer: 1**

## Explanation

Correct (2): Behavioral adverse effects — irritability, aggression, mood changes, depression, suicidal ideation — are well-documented levetiracetam side effects, especially in children and adolescents. Some clinicians add pyridoxine (B6) which may attenuate symptoms; otherwise switching agents. (1) Dismisses a known adverse effect. (3) Higher dose worsens behavior. (4) Abrupt discontinuation risks seizure rebound.

## In-depth explanation

Memory Tip Levetiracetam = "Lev-er-RAGE-tam" — irritability and rage. CPG Screen for mood/behavior at every follow-up; suicide risk warning class-wide for anticonvulsants.

## Clinical scenario

Scenario 10-year-old boy started levetiracetam 250 mg PO BID 3 weeks ago for new generalized epilepsy. Parents report new irritability, aggression, and outbursts at school. Seizures controlled.

## Key concepts

- **Levetiracetam behavioral effects** — Irritability, aggression, depression, and rarely suicidal ideation; common reason for switching this otherwise well-tolerated drug.
- **Pyridoxine (vitamin B6)** — Supplement sometimes added to mitigate levetiracetam behavioral side effects.
- **Suicidality warning** — FDA class warning for anticonvulsants; screen all patients on chronic therapy.

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