Do you use vitamin B6 to help with Keppra irritability?

I am an adult epileptologist and do not routinely prescribe pyridoxine for neuropsychiatric adverse effects of levetiracetam. I do see this done a lot more in the pediatric population, where there is more data than is available in the adult population (though still not of very high quality). Anecdot...

I prefer transitioning from Keppra to another more effective option, but I'm open to using B6. Despite literature warnings about B6 toxicity, in my 20 years of clinical practice as a Neuromuscular subspecialist, I've rarely encountered B6 toxicity, even in patients with elevated serum B6 levels. Act...

I switch. In my experience, vitamin supplementation is not effective. It also results in adding on another pill for the patient when they could easily switch to a different antiepileptic. If they're on Keppra monotherapy, there are lots of alternatives. I would only do a trial of vitamin supplementa...

I switch therapy too, especially when options are available. This leads to an improved patient's quality of life rather than 6 to 8 weeks of added neuropsychiatric adverse effects.

I have tried vitamin B6 in the past with limited results.

I agree with the previous responses. In my practice, I've found success with B6 in situations where a patient shows remarkable responsiveness to levetiracetam, and there's concern about losing that benefit. Additionally, this applies when the neuropsychiatric side effects of levetiracetam are relati...

I primarily work with patients experiencing tumor-related epilepsy and have noticed that B6 is very helpful in curbing irritability. However, since this symptom is dose-dependent, I opt to change to a different ASM if seizures aren't controlled. I haven't had any patients develop neuropathy from B6 ...