Levetiracetam in epilepsy and autism spectrum disorder: analysis of safety, tolerability, and efficacy

Purpose: One in five people with autism spectrum disorder have epilepsy and take Anti-Seizure Medications (ASM). However, the impact of ASM on people with autism is under researched. This study evaluates the efficacy and tolerability of Levetiracetam (LEV) for autistic people and epilepsy. Method: Data was derived from the English Epilepsy Research Database Register which compares ASM responses in those with neurodevelopmental disorders to those without. Age range was 18–50 years as there were no autistic research participants with autism prescribed LEV over 50. Twelve-month ASM data, including withdrawal rate, seizure frequency and adverse effects were compared. Fisher's exact test was used to assess univariate associations between outcomes and autism with significance accepted as p < 0.05. Logistic regression was used to assess autism group differences after adjustment for potential confounders (age, gender, presence of baseline physical and mental health conditions). Results: Of 175 (aged 18–50) research participants across 18 NHS Trusts, prescribed LEV between 2000 and 2020, 40 were autistic. There was no significant association between withdrawal rate (P = 0.626), or grouped side effects (physical P = 0.165, mental health P = 0.791). Autism was significantly associated with aggression with LEV in univariable analysis but this association was no longer significant after accounting for multiple testing A significant non-linear relationship between efficacy and the autism group (P < 0.001) was found. Conclusions: This study supports the use of LEV for people with autism and epilepsy as there is no difference in response noted to those without autism. However, they may have less prominent changes in efficacy.