My brother has seizures despite Levetiracetam. What to do?

Question

Hello doctor,

My brother, aged 25, was diagnosed with focal epilepsy last year after an EEG showed abnormal discharges in the left temporal region.

He is on Levetiracetam 500 mg twice daily, but still had one episode last month. The MRI of the brain was normal. So my concerns are -

Could his dose be insufficient, or should we add another medicine?
Additionally, he often feels irritated and sleepy; are these side effects of the drug or a result of the condition itself?
Is it safe for him to drive once he is seizure-free for a few months, or does he need longer observation before resuming driving or heavy work?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

From what you described, your brother’s condition is consistent with focal epilepsy involving the left temporal lobe, and it sounds like his treatment is helping but may not yet be fully optimized.

Levetiracetam 500 mg twice daily is a common starting dose. Still, depending on his body weight, seizure frequency, and tolerance, many adults require a higher dose, sometimes up to 1500 mg twice daily, to achieve complete seizure control.

Since he still had a breakthrough episode after several months on this dose, his neurologist may consider gradually increasing the Levetiracetam or, if seizures persist despite adequate dosing, adding another antiseizure medication such as Lamotrigine, Carbamazepine, or Lacosamide.

These decisions depend on his EEG (electroencephalogram) pattern, side effects, and overall response to the treatment.

The irritability, mood swings, and sleepiness he is experiencing are well-recognized side effects of Levetiracetam, not necessarily signs that the epilepsy itself is worsening.

Mood changes, fatigue, and sometimes mild depression can occur, particularly in the first few months of therapy or when doses are adjusted.

If these symptoms are troublesome, his doctor might lower the dose slightly, add a mood-stabilizing supplement like vitamin B6 (which sometimes helps), or consider switching to another antiseizure medication with fewer behavioral effects.

Regarding driving, most countries have strict safety rules. In general, a person with epilepsy should be seizure-free for at least six to 12 months before resuming driving or operating heavy machinery. This ensures stability on medication and lowers the risk of an accident.

Even if he feels well for a few months, it is best to wait until his neurologist officially clears him, since laws and medical guidelines vary by region.

For now, he should continue taking his medication regularly without missing doses, maintain adequate sleep, avoid alcohol or sleep deprivation, and follow up closely with his neurologist.

With the right medication adjustment and good adherence, many people with focal epilepsy achieve long-term seizure control and lead completely normal lives.

I hope this helps.

Thank you and take care.

Regards.