Seizure Prophylaxis After Intracerebral Hemorrhage in a Patient With Psychiatric Illness: A Case Report

Psychiatric comorbidities are highly prevalent in patients with epilepsy. This can complicate the management of seizures, as antiseizure medications (ASMs) can interact with psychotropic drugs or worsen psychiatric symptoms. We report the case of a 70-year-old woman with schizophrenia and bipolar disorder who presented with acute confusion and was found to have an elevated serum lithium level and an acute right temporal lobe intraparenchymal hemorrhage. Levetiracetam was initiated for seizure prophylaxis but was discontinued due to concern for psychiatric side effects. Oxcarbazepine was started and provided seizure protection with better psychiatric tolerability. This case illustrates the unique challenges of seizure prophylaxis in patients with psychiatric comorbidities.