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1533 - Managing Auditory Hallucinations and Seizure Control: A Case Study of Keppra-Induced Psychiatric Symptoms in a Patient with Temporal Lobe Injury

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

EP

Evan C. Purvis, MD

Resident Physician
Northwell Health at Zucker School of Medicine
Mineola, New York, United States

Co-Author(s)

LH

Lisa P. Hu, MD

Vice-Chair PMR, Glen Cove Hospital; Assistant Professor, Hofstra-Northwell School of Medicine
Northwell Health-Glen Cove Hospital
Sea Cliff, New York, United States
AK

Aerren Kublal, PMHNP

C&L Psychiatric Nurse Practitioner
Northwell Health - Glen Cove Hospital
Glen Cove, New York, United States

Case Diagnosis: Auditory Hallucinations after Initiation of Keppra

Case Description: An 80-year-old female was admitted to the Brain Injury Unit for rehabilitation following breakthrough seizures. Over a six-month period, she was hospitalized three times for recurring seizures, despite having no prior seizure history. Work up ruled out viral and autoimmune encephalitis but revealed cerebral vasogenic edema. During her second hospitalization, an MRI demonstrated an acute hematoma in the left temporal lobe. Her most recent hospitalization involved multiple antiepileptic medication adjustments, including Vimpat and Keppra. Upon rehabilitation admission, she exhibited severe distress, intermittent crying, psychomotor agitation, and circumferential speech. Notably, she reported auditory hallucinations and persistent delusions involving her husband filing for divorce.

Discussions: Psychiatry was consulted and suggested that Keppra might contribute to hallucinations and anxiety. However, given the temporal lobe injury and history of breakthrough seizures, altering the antiepileptic regimen was not advised. Instead, psychiatry recommended initiating an antipsychotic. This led to significant improvement in mood, anxiety, memory, and task focus, and the patient eventually gained insight into her hallucinations. Keppra, while effective for seizure control, is known for psychiatric side effects like hallucinations, agitation, and anxiety. This case emphasizes the need to consider psychiatric effects when prescribing seizure medications and the importance of a multidisciplinary approach in managing complex cases with both neurological and psychiatric symptoms. Temporal lobe injury impacts seizure risk, short-term memory, and the auditory cortex, illustrating syndromes related to left temporal lobe injuries.

Conclusions: This case highlights the complex interaction between antiepileptic medications and psychiatric symptoms in brain injury patients. The marked improvement with Abilify underscores the necessity of monitoring psychiatric side effects of medications like Keppra. A multidisciplinary approach is essential for effective management of both neurological and psychiatric symptoms, optimizing patient outcomes in acute inpatient rehabilitation.