Efficacy and tolerability of levetiracetam versus phenytoin after supratentorial neurosurgery.
BACKGROUND
Antiepileptic drugs are routinely given after craniotomy. Though phenytoin (PHT) is still the most commonly used agent, levetiracetam (LEV) is increasingly administered for this purpose. This retrospective study compared the use of LEV and PHT as monotherapy prophylaxis following supratentorial neurosurgery.


METHODS
Patients receiving LEV monotherapy after supratentorial craniotomy were reviewed and compared to a control group of patients receiving PHT monotherapy.


RESULTS
One of 105 patients taking LEV and 9/210 patients taking PHT had seizures within 7 days of surgery (p = 0.17). Adverse drug reactions requiring change in therapy during hospitalization occurred in 1/105 patients taking LEV and 38/210 patients taking PHT (p < 0.001). Among patients followed for at least 12 months, 11/42 (26%) treated with LEV vs 42/117 (36%) treated with PHT developed epilepsy (p = 0.34); 64% remained on LEV, while 26% remained on PHT (p = 0.03).


CONCLUSIONS
Both levetiracetam (LEV) and phenytoin (PHT) were associated with a low risk of early postoperative seizures and a moderate risk of later epilepsy. LEV was associated with significantly fewer early adverse reactions than PHT and with a higher retention rate in patients who were followed for at least 1 year and developed epilepsy.
Milligan
Tracey A
TA
Department of Neurology, Department of Medicine, Brigham & Women's Hospital, 75 Francis St., Boston, MA 02115, USA. tmilligan@partners.org
Hurwitz
Shelley
S
Bromfield
Edward B
EB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D001921:Brain / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D001930:Brain Injuries / Q000150:complications / Q000601:surgery; D004361:Drug Tolerance / Q000502:physiology; D064420:Drug-Related Side Effects and Adverse Reactions; D004827:Epilepsy / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010672:Phenytoin / Q000008:administration & dosage* / Q000009:adverse effects; D010889:Piracetam / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000517:prevention & control; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome
D000927:Anticonvulsants; D000077287:Levetiracetam; D010672:Phenytoin; D010889:Piracetam