ICE Clinical Pearl:

Vitamin B6 for behavioral improvement in children on Keppra (levetiracetam)

Vitamin B6 (pyridoxine) supplementation may be useful  in children with behavioral disorders associated with Keppra (levetiracetam).   While there are not well controlled clinical trials, Vitamin B6 is inexpensive and

safe at appropriate doses.  The doses used were 100 – 200 mg/day with an average of 6 mg/kg/day (Major, Epil & Behav 2008).  Doses above 1000 mg/day are associated with peripheral neuropathy.

Major et al reports twenty-two patients started on  pyridoxine after being on Keppra, and significant behavioral improvement  was observed in nine (41%), no effect in eight (36%), deterioration in four (18%), and an uncertain effect in one. The effects of pyridoxine supplementation were observed during the first week. This group is planning a placebo controlled cross over study.   Davis et al (Adv Ped Psych 2009) published a case report of vitamin B6 supplementation in a 6 year old boy with epilepsy in which treatment with  levetiracetam caused behavioral abnormalities that resolved after supplementation with pyridoxine.

References

Davis G, McCarthy J, Magill et al.  Behavioral Effect of Levetiracetam Mitigated by Pyridoxine.  Adv Ped Psych 2009;19(2):209-211.

Major P, Greenberg E, Khan A et al.  Pyridoxine supplementation for the treatment of levetiracetam induced behavioral side effects in children:  Preliminary results.  Epil & Behav 2008;13(3):557-59.

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