Beyond behavioral activation: A prospective item-level analysis of the neuro-psychiatric trajectory of pediatric epilepsy patients treated with levetiracetam.

Authors

Deniz Menderes, Yasemin Taş Torun, Samet Can Demi̇rci̇, Tuğba Hirfanoğlu, Kıvılcım Gücüyener, Ayşe Serdaroğlu, Ercan Demi̇r, Ebru Arhan

Published in

Epilepsy research. Volume 227. Pages 107878. Jul 21, 2026. Epub Jul 21, 2026.

Abstract

Levetiracetam (LEV) is widely used in pediatric epilepsy but is often associated with behavioral adverse effects. However, its impact on internalizing symptoms such as anxiety and depression remains insufficiently explored. This study aimed to evaluate longitudinal changes in depressive and anxiety symptoms following LEV initiation using both total scores and item-level analyses.
A prospective clinical follow-up study was conducted in 35 pediatric epilepsy patients (mean age: 12.2 ± 3 years). Psychometric assessments were performed at baseline and during the maintenance phase using the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory for Children (STAIC). Pre- and post-treatment scores were compared using non-parametric tests, and item-level analyses were conducted to descriptively examine changes across specific symptom domains.
Thirty patients completed the longitudinal evaluation. LEV did not demonstrate a significant change in BDI scores (9.83 ± 9.55 vs. 10.13 ± 9.86; p = 0.68). In contrast, state anxiety significantly decreased (STAIC-1: 40.83 ± 9.04 vs. 36.2 ± 12.36; p = 0.011), while trait anxiety showed a non-significant reduction. Item-level analysis supported the overall stability of depressive and anxiety symptoms. Behavioral activation requiring treatment discontinuation occurred in 8.5% of patients and was observed early after treatment initiation.
In this cohort, levetiracetam was not associated with a significant increase in depressive or anxiety symptoms. The observed reduction in state anxiety should be interpreted cautiously and may be influenced by multiple factors beyond treatment effects. Item-level analysis may provide additional clinical insight by distinguishing transient behavioral changes from clinically significant psychiatric deterioration. Given the limited sample size and absence of a control group, findings should be considered descriptive and warrant confirmation in larger, controlled studies.

PMID:
42485675
Bibliographic data and abstract were imported from PubMed on 23 Jul 2026.

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