Levetiracetam versus phenytoin for seizure prophylaxis in severe traumatic brain injury.
OBJECTIVE
Current standard of care for patients with severe traumatic brain injury (TBI) is prophylactic treatment with phenytoin for 7 days to decrease the risk of early posttraumatic seizures. Phenytoin alters drug metabolism, induces fever, and requires therapeutic-level monitoring. Alternatively, levetiracetam (Keppra) does not require serum monitoring or have significant pharmacokinetic interactions. In the current study, the authors compare the EEG findings in patients receiving phenytoin with those receiving levetiracetam monotherapy for seizure prophylaxis following severe TBI.


METHODS
Data were prospectively collected in 32 cases in which patients received levetiracetam for the first 7 days after severe TBI and compared with data from a historical cohort of 41 cases in which patients received phenytoin monotherapy. Patients underwent 1-hour electroencephalographic (EEG) monitoring if they displayed persistent coma, decreased mental status, or clinical signs of seizures. The EEG results were grouped into normal and abnormal findings, with abnormal EEG findings further categorized as seizure activity or seizure tendency.


RESULTS
Fifteen of 32 patients in the levetiracetam group warranted EEG monitoring. In 7 of these 15 cases the results were normal and in 8 abnormal; 1 patient had seizure activity, whereas 7 had seizure tendency. Twelve of 41 patients in the phenytoin group received EEG monitoring, with all results being normal. Patients treated with levetiracetam and phenytoin had equivalent incidence of seizure activity (p = 0.556). Patients receiving levetiracetam had a higher incidence of abnormal EEG findings (p = 0.003).


CONCLUSIONS
Levetiracetam is as effective as phenytoin in preventing early posttraumatic seizures but is associated with an increased seizure tendency on EEG analysis.
Jones
Kristen E
KE
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Puccio
Ava M
AM
Harshman
Kathy J
KJ
Falcione
Bonnie
B
Benedict
Neal
N
Jankowitz
Brian T
BT
Stippler
Martina
M
Fischer
Michael
M
Sauber-Schatz
Erin K
EK
Fabio
Anthony
A
Darby
Joseph M
JM
Okonkwo
David O
DO
D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015331:Cohort Studies; D004569:Electroencephalography / Q000187:drug effects / Q000379:methods; D004834:Epilepsy, Post-Traumatic / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000008:administration & dosage*; D010889:Piracetam / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011446:Prospective Studies; D055815:Young Adult
D000077287:Levetiracetam; D010672:Phenytoin; D010889:Piracetam