Levetiracetam-induced excessive beta activity: a drug effect on EEG

Background Levetiracetam (LEV) is a widely prescribed antiseizure medication (ASM) with a favorable safety profile. While its clinical efficacy is well established, the impact of LEV on EEG background rhythms remains poorly understood. This study investigates the prevalence and clinical correlates of LEV-induced Excessive β Activity (LEV-EBA) in patients with epilepsy. Methods A retrospective observational study was conducted at the National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia. EEG records performed between January 2022 and January 2023 were reviewed for patients aged 1-19 years receiving LEV therapy. EBA identified by visual analysis. Patients receiving benzodiazepines or barbiturates, as well as those with potential neurological or psychiatric confounding conditions, were excluded. Demographic and clinical characteristics were summarized using descriptive statistics. Results Of 425 patients, LEV-EBA was identified in 302 (71.1%). Patients with LEV-EBA were significantly younger than those without LEV-EBA (mean age: 7.90 ± 4.49 vs. 12.20 ± 4.90 years, P < 0.001). Prevalence was significantly higher in children aged ≤5 years (112 out of 122, 37.1%, p<0.001). No significant associations were observed with sex, epilepsy aetiology, epilepsy classification, EEG classification, abnormal EEG findings, patient state during EEG recording, or concomitant ASM use. Conclusion LEV-EBA is a common, age-dependent EEG phenomenon, particularly in young children, and diminishes with age. This pattern is similar to benzodiazepines and barbiturates, which typically produce generalized beta enhancement. Awareness of LEV-EBA may prevent misinterpretation of EEG findings. Further multicenter studies that include adult populations and dose–response analyses are needed to clarify its clinical significance.