I take Levetiracetam for seizures. Should I alter the dosage?

Question

Hello doctor,

I am a 28-year-old female and had my first tonic-clonic seizure last month. My EEG showed occasional sharp waves in the temporal lobe; the MRI was normal. I started Levetiracetam 500 mg twice daily, but I still feel dizzy and sometimes confused afterward.

Last laboratory tests showed potassium at 3.4 mmol/L and normal sodium. And, I have a few questions to ask you -

Should I get additional tests to rule out thyroid or metabolic causes?
How do doctors decide if a dose adjustment or another medication is needed?
Can lifestyle factors like sleep, caffeine, and stress significantly reduce recurrence risk?
Is it safe to continue my oral contraceptive while taking Levetiracetam, or could they interact?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Since this was your first tonic-clonic seizure and your EEG (electroencephalogram) showed temporal sharp waves, your neurologist’s decision to start Levetiracetam was appropriate, as it helps prevent recurrence even with a standard MRI (magnetic resonance imaging).

The dizziness and confusion you are experiencing can sometimes be medication side effects, but they can also occur after seizures themselves. Your mildly low potassium (3.4 mmol/L) could contribute to neurological symptoms and should be corrected, though normal sodium is reassuring.

Additional basic tests, such as thyroid function, calcium, magnesium, kidney and liver function, and vitamin B12 or folate, are often checked once to rule out reversible metabolic contributors, especially when seizures occur in otherwise healthy young adults.

Doctors decide on dose adjustment or switching medication by weighing seizure control against side effects. If seizures persist, or if side effects are intolerable, the dose may be carefully increased or an alternative drug considered. Lifestyle plays a significant role in adequate sleep, stress reduction, avoiding excess caffeine and alcohol, and maintaining good hydration, significantly lowering recurrence risk.

As for contraception, Levetiracetam does not reduce the effectiveness of oral contraceptives, unlike some older anti-seizure drugs (for example, Carbamazepine or Phenytoin), so it is safe to continue.

I hope this helps.