Differences in aggression as psychiatric side effect of levetiracetam and perampanel in patients with epilepsy

•We compared aggression between levetiracetam and perampanel, using specialized tools.•Levetiracetam increased hostility score as compared to perampanel.•Perampanel can induce easily visible outward-directed aggression.•Levetiracetam can induce subjectively inward-directed aggression.•Aggression provoked by LEV can lead to more diverse expression and misrecognition.