Reversible bilateral ptosis after levetiracetam administration in a 4-year-old girl: A case report

Levetiracetam (LEV) is a frequently prescribed antiseizure medication for focal epilepsy in children because of its high efficacy and relatively mild side effects. We report a case of reversible bilateral ptosis following LEV administration. A 4-year-old girl presented with unprovoked focal to bilateral tonic-clonic seizures, which had occurred at least twice since the age of 3 years and 10 months. The patient was initially diagnosed with focal epilepsy, and was treated with LEV at a dose of 20 mg/kg/day. After one week of treatment, the patient developed bilateral ptosis without diurnal fluctuation. After a month, LEV was discontinued and the patient's treatment was changed to perampanel. Various tests were performed to rule out myasthenia gravis; however, no significant findings were observed. The patient's ptosis gradually improved over the three months following the cessation of LEV. Although an exact causal relationship is challenging, the clinical course suggests that LEV may induce ptosis in patients with focal epilepsy. Herein, we report detailed clinical information because ptosis is not a known side effect of LEV treatment; therefore, understanding this newfound side effect is important given the widespread use of LEV.