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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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My 35 year old sister was diagnosed with a cavernoma on the

Customer Question

Hello,
My 35 year old sister was diagnosed with a cavernoma on the left side of her brain in September after a seizure. She had brain surgery at Brigham & Women's in Boston in October. She remains on 1000 mg of keppra for a total of 6 months until the EEG and MRI are repeated.
The surgeon mentioned this was the better part of the brain for this to occur and should not affect too much as far as function and she is expected to make a full recovery.
I have noticed she tires easily still 3 months post surgery and is also exptremely emotional and weepy at times. She does work full time and went back rather quickly after a month.
My question is. Is this a normal finding after such an event? a side effect of keppra? Will this resolve over time?
We are concerned and so want her to return to her normal self .
Submitted: 11 months ago.
Category: Neurology
Expert:  Dr. Frank replied 11 months ago.

Hello welcome to JA. I will review your statement and reply shortly. Please read this preliminary answer and respond. Dr Frank

Customer: replied 11 months ago.
I didn't see the preliminary answer
Expert:  Dr. Frank replied 11 months ago.

HI. Sorry, I was busy with a patient and was distracted. The answer is dependant on the exact location of the cavernoma and how difficult the removal process was. Cavernomas are very common, I have had several patients with them, with seizures and without. In part, seizures are tied to cavernomas because of the superficial location on the surface of the brain, in the grey matter or cortical area, in a position to cause focal seizures to occur. Keppra (levetiracetam) is really the AED (anti epileptic drug) of choice for these lesions and 1000 mg a day is a small dose, with the usual dose being 3 times that. The drug itself is linked to some unusual reactions, including an "anger management" type reaction with inappropriate emotional outbursts. This was described and published by a doctor from NYU, he runs the epilepsy center, and showed that by reducing the daily dose slightly, the emotional incontinence stops. But it could be either the drug or the location of the cavernoma, especially if in the temporal lobe which I suspect it was. If she is right handed, that is a difficult location as it is very complex and filled with "eloquent" cortex, important areas for daily function. If it is due to either situation, it should resolve with time, but you might have her ask her neurologist about Dr Devinski's work showing changes in emotion with reduction of the keppra dose. I hope that helps Get back to me to discuss or rate my service if satisfied with this answer by clicking on the rating stars Thanks Dr Frank

Expert:  Dr. Frank replied 10 months ago.

Please get back to me to discuss this further if I can help. Dr Frank

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