Levetiracetam in idiopathic generalised epilepsy and porphirya cutanea tarda: a case report

Purpose: Many drugs inducing hepatic metabolism, in particular the cytochrome P-450 system, can exacerbate latent porphyrias because they increase heme synthesis. Consequently, non-inducing antiepileptic drugs (AEDs) are usually considered a safe choice in epilepsy patients with porphyrias. However, there are several reports which describe porphyrinogenic activity in non-inducingAEDs as well. Treatment of epileptic seizures in patients with porphyrias may consequently be a challenge. Method: In this case report we are the first to describe levetiracetam usage in porphyria cutanea tarda, the most common form of porphyria. So far, only two reports of levetiracetamuse in porphyria are found in the literature, one describing use in coproporphyria and the other in acute intermittent porphyria. Our patient is a 50 year old male affected by idiopathic generalised epilepsy and porphyria cutanea tarda. Valproate and phenobarbital controlled seizures but exacerbated porphyric symptomatology, while clobazam, clonazepam and lamotrigine were safe on porphyric disturbances but did not control seizures. Results: Levetiracetam monotherapy was accompanied by complete control of seizures and normal liver function and blood count. Conclusion: Lack of hepatic metabolism in levetiracetam might rep- resent an indicator of its safety in porphyric patients.However, evaluation of experimental models of porphyria is warranted for levetiracetam and for all new AEDs.