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What Does Vision Issues When On Keppra Indicate?
Question: I am taking Keppra for elecrolyte abnormality under treatment from a fine local neurologist, whom I finally saw after several years of severe no-warning falls. I have been on it since last XXXXXXX and had no side effects. For the past two days I found in driving southward the lines of the two lanes on the highway were interrsecvting into an x. I saw my opthomologist right away and he diagnosed transient cyclotoresian (sp?), or 4th nerve perisis (sp. paresis?) He said it might just go away, he'd never heard of Keppra and did not look it up. I am now afraid to drive, altho' this didn't occur driving northward. I have no idea what to do or expect and I am frightened. I am 72, have no heart disease or other problems other than normal arthritis for my age. I'm scared. I called my neurologist but she is not in. My husbsand cannot drive because of macular degeneration. If I dont' drive, we are stuck. What would you suggest, Dr.?
Brief Answer:
Trochlear (4th nerve) nerve palsy can have different causes.
Detailed Answer:
I read your question carefully and I understand your concern.
Regarding Keppra, it is not clear what you mean by electrolyte abnormality, it is not used for that indication. Keppra (Levetiracetam) is a drug which is used to prevent epileptic seizures, which should be your case considering your history of recurring no-warning falls. At times Keppra can cause vision abnormalities like double vision, but apart from being rare they are not likely after 9 months of treatment with no issues.
It seems that your ophthalmologist has noticed a trochlear nerve (4th nerve) palsy. That is a nerve which innervates one of the muscles directing eye movements, and the lack of action of that muscle means the movements of the two eyes are not well aligned with each other, you should be able to see fine with each eye separately.
The most common cause is head trauma, not your case apparently. So other causes must be searched after like diabetes or stroke. Rarely can it be in the setting of myasthenia gravis or thyroid dysfunction, but usually these would have other manifestations eventually. At times as your ophthalmologist said the cause can't be found.
In most cases it does gradually improve and given the fact that it seems to be a mild or even transitory one in your case one can be optimist in that regard. However I suggest that a medical evaluation even in the ER is necessary to look for other possible signs and tests, both lab tests for diabetes as well as imaging preferably with MRI of the brain and blood vessels.
I remain at your disposal for further questions.
Trochlear (4th nerve) nerve palsy can have different causes.
Detailed Answer:
I read your question carefully and I understand your concern.
Regarding Keppra, it is not clear what you mean by electrolyte abnormality, it is not used for that indication. Keppra (Levetiracetam) is a drug which is used to prevent epileptic seizures, which should be your case considering your history of recurring no-warning falls. At times Keppra can cause vision abnormalities like double vision, but apart from being rare they are not likely after 9 months of treatment with no issues.
It seems that your ophthalmologist has noticed a trochlear nerve (4th nerve) palsy. That is a nerve which innervates one of the muscles directing eye movements, and the lack of action of that muscle means the movements of the two eyes are not well aligned with each other, you should be able to see fine with each eye separately.
The most common cause is head trauma, not your case apparently. So other causes must be searched after like diabetes or stroke. Rarely can it be in the setting of myasthenia gravis or thyroid dysfunction, but usually these would have other manifestations eventually. At times as your ophthalmologist said the cause can't be found.
In most cases it does gradually improve and given the fact that it seems to be a mild or even transitory one in your case one can be optimist in that regard. However I suggest that a medical evaluation even in the ER is necessary to look for other possible signs and tests, both lab tests for diabetes as well as imaging preferably with MRI of the brain and blood vessels.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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