Neurology · USMLE Step 1 and Step 2

Levetiracetam, Lamotrigine & Topiramate song

Levetiracetam, Lamotrigine & Topiramate, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

Levetiracetam, Lamotrigine & Topiramate

Full song on YouTube ↗Spotify ↗

Key points in this song10

Levetiracetam binds SV2A (synaptic vesicle glycoprotein 2A), reducing neurotransmitter release; it is a broad-spectrum AED used for focal, generalized tonic-clonic, and myoclonic seizures.
Levetiracetam has minimal drug-drug interactions and no hepatic enzyme induction or inhibition, making it preferred in patients on polypharmacy (e.g., transplant, anticoagulation).
Key adverse effect of levetiracetam: irritability, aggression, and psychiatric symptoms ("levetiracetam rage"); managed by dose reduction or switching agents.
Lamotrigine blocks voltage-gated sodium channels and is first-line for focal seizures, generalized seizures, and the drug of choice for seizures in pregnancy due to the safest fetal profile among AEDs.
Lamotrigine requires slow titration to minimize risk of Stevens-Johnson Syndrome (SJS); risk is dramatically increased when co-administered with valproate, which inhibits lamotrigine glucuronidation and doubles its half-life.
Lamotrigine is also FDA-approved for bipolar I disorder maintenance; it is mood-stabilizing but ineffective for acute mania.
Topiramate blocks sodium channels, enhances GABA-A activity, and inhibits kainate/AMPA glutamate receptors; it is broad-spectrum and also approved for migraine prophylaxis and weight loss (with phentermine).
Classic topiramate adverse effects: cognitive slowing ("Dopamax"), word-finding difficulty, weight loss, and metabolic acidosis due to carbonic anhydrase inhibition.
Topiramate inhibits carbonic anhydrase, causing hypocitraturia and hypercalciuria, which predisposes patients to calcium phosphate kidney stones — a classic USMLE association.
Topiramate is teratogenic (cleft palate/lip) and is contraindicated in pregnancy; lamotrigine is preferred when seizure control is required in pregnant women.