QOL-07. Vitamin B6 supplementation for levetiracetam-associated mood changes in patients with brain tumor-related epilepsy

Abstract Seizures are a common and debilitating complication of primary brain tumors. Nearly 75% of low-grade and 25% of high-grade glioma patients experience seizures. Levetiracetam (LEV) is frequently used as first-line to treat seizures in glioma patients. Side effects such as agitation, irritability, and insomnia are common with LEV, leading to medication discontinuation or transition to an alternative antiseizure medication. Behavioral symptoms tend to occur within 4 weeks after initiating LEV. Multiple retrospective studies, primarily in pediatric epilepsy, have suggested that Vitamin B6 (VitB6; pyridoxine) supplementation reduces irritability associated with LEV and reduces LEV discontinuation. There are currently no data available for brain tumor patients. We sought to explore the potential benefits of VitB6 supplementation in patients with brain tumor-related epilepsy (BTRE) who are on LEV. We retrospectively identified patients at our institution with the following characteristics: 1. Known primary brain tumor, 2. Known BTRE, 3. Active prescriptions for LEV and VitB6. In this IRB-approved investigation, we queried pertinent demographics, LEV adherence, and reported mood-related symptoms. Ten patients were identified on concomitant LEV and VitB6 in March 2025. VitB6 dosage was 100 mg PO daily for nine patients and 50 mg PO daily for one patient. Six patients had underlying psychiatric comorbidities. As of June 2025, all patients have remained on LEV with concurrent VitB6 supplementation. Data collection is ongoing for adherence and mood symptomatology. To date, 90% of the cohort had available data regarding mood. Four patients reported improved mood symptoms since VitB6 initiation. Three patients reported stable mood. Two reported worsening mood symptoms. Of the two patients reporting worsening mood, one noted improved mood irritability but worsening depressive symptoms. Early concomitant VitB6 with LEV in brain tumor patients may improve LEV adherence and lessen mood-related side effects. A prospective clinical trial would be beneficial for continuing this exploration.