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Aims and background Brain metastases occur in about 30% of patients with non-small-cell lung carcinoma; seizures occur in approximately 20% of them. Antiepileptic drugs are commonly given for postoperative prophylaxis after brain or metastasis tumor surgery. The incidence of seizures following supratentorial craniotomy is estimated to be 15%-20%. Postoperative seizures are more common in the first month after cranial surgery. However, the use of antiepileptic drugs postoperatively has been investigated in randomized controlled trials. In case of seizures, the recommendations are continuing antiepileptic drugs after a 1- to 4-year seizure-free interval. This decision must weigh the risk of seizure recurrence against the possible benefits of the drug. Some antiepileptic drugs have been known to cause blood dyscrasias, including neutropenia, but this is a rare occurrence. Methods We report a case of neutropenia related to the use of levetiracetam at first exposure. After drug administration, neutropenia was detected. Additional tests were performed. Results By exclusion, it was decided to withdraw the drug, and the patient had a reversal of neutropenia. Conclusions Levetiracetam-induced neutropenia is infrequent but possible. It is an exclusion diagnosis.