Levetiracetam is associated with improved cognitive outcome for patients with intracranial hemorrhage.
BACKGROUND
To date, common therapy in patients with intracranial hemorrhage (ICH) includes prophylaxis of seizure using antiepileptic drugs, commonly phenytoin. Phenytoin therapy is associated with a high incidence of cognitive disturbance. Levetiracetam is known to cause less cognitive disruption and may be a suitable alternative for seizure prophylaxis. Cognitive outcomes in ICH patients receiving seizure prophylaxis with levetiracetam or phenytoin are compared.


METHODS
A retrospective chart review was conducted with 269 patients who received prophylactic levetiracetam or phenytoin between August 2005 and May 2008. A total of 85 reviewed patients met inclusion criteria (phenytoin n = 25, levetiracetam n = 60).


RESULTS
Statistically significant results included higher Glasgow Coma Scores (GCS) at dismissal (median, 14 vs. 11, P = 0.023), lower seizure incidence (0.0 vs. 8%, P = 0.03) for patients receiving levetiracetam than those treated with phenytoin and patients being discharged home (21.7% vs. 16%, P = 0.03). Observed trends included greater cognitive function retention rate (56.7% vs. 36%, P = 0.08).


CONCLUSIONS
Despite similarities in hemorrhage type and severity at onset, patients receiving levetiracetam had better cognition at discharge and fewer seizures than patients receiving phenytoin. These data suggest that levetiracetam is more effective than phenytoin for seizure prophylaxis without suppression of cognitive abilities in patients with ICH.
Taylor
Scott
S
Department of Pharmacy, Via Christi Regional Medical Center, University of Kansas School of Medicine, KS, Wichita, USA. Scott.Taylor@ViaChristi.org
Heinrichs
Robin J
RJ
Janzen
Jeff M
JM
Ehtisham
As'ad
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000627:therapeutic use; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D055815:Young Adult
D000927:Anticonvulsants; D000077287:Levetiracetam; D010672:Phenytoin; D010889:Piracetam