Does Levetiracetam impact fertility?

Question

Hi doctor,

My 28-year-old girlfriend had her first generalised tonic-clonic seizure last month while sleeping. The MRI of the brain was normal, but the EEG showed occasional spikes in the right temporal lobe. Her neurologist recommended Levetiracetam 500 mg twice daily, but she is anxious about mood side effects and whether this could impact her fertility or future pregnancy plans. Is there a role for additional imaging, such as PET or sleep EEG?

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

The spikes in the right temporal lobe suggest a focal epilepsy (temporal lobe epilepsy) that is secondarily generalized during sleep, which is not uncommon. Normal MRI (magnetic resonance imaging) is a good sign, as it rules out many structural causes (tumors and malformations).

Levetiracetam benefits versus concerns:

Pros:

Broad-spectrum AED (anti-epileptic drug), well-tolerated by many, does not require blood level monitoring, has a low risk of liver or organ toxicity, so it is the best option to use.

Concerns:

Mood changes: Irritability, anxiety, or depression can occur in up to 10 to 20 percent of patients. People with a history of mood disorders may be more sensitive. If this becomes an issue, alternatives like Lamotrigine or Brivaracetam (a similar but often better-tolerated drug) may be considered.
Fertility or pregnancy: Levetiracetam is one of the safest options in pregnancy among AEDs. Classified as category B (no known risk in humans). No known effect on fertility. Folic acid 4 to 5 mg daily is strongly recommended before and during pregnancy if she stays on any AED. Since MRI is normal and EEG (electroencephalogram) already showed abnormalities, further tests depend on how detailed the epilepsy work-up needs to be:
Sleep-deprived EEG or overnight video EEG: These can increase the yield of epileptiform activity, especially if the spikes are infrequent or sleep-related.
PET (positron emission tomography) or SPECT (single photon emission computed tomography) scans: Generally not first line unless there is a surgical consideration (e.g., in drug-resistant epilepsy). MRI is normal, but high suspicion of focal cortical dysplasia or subtle abnormality. For now, with a single seizure and one abnormal EEG, routine follow-up and medication trial are appropriate. PET or advanced imaging may be considered if seizures continue despite medication.

Lifestyle advice:

Adequate sleep (sleep deprivation can trigger seizures).
No alcohol or recreational drugs.
Avoid driving until cleared by a neurologist.
Track seizure frequency, timing, and triggers (a seizure diary helps).

I hope this information will help you.

Thanks.