Phenytoin versus Leviteracetam for seizure prophylaxis after brain injury - a meta analysis.
BACKGROUND
Current standard therapy for seizure prophylaxis in Neuro-surgical patients involves the use of Phenytoin (PHY). However, a new drug Levetiracetam (LEV) is emerging as an alternate treatment choice. We aimed to conduct a meta-analysis to compare these two drugs in patients with brain injury.


METHODS
An electronic search was performed in using Pubmed, Embase, and CENTRAL. We included studies that compared the use of LEV vs. PHY for seizure prophylaxis for brain injured patients (Traumatic brain injury, intracranial hemorrhage, intracranial neoplasms, and craniotomy). Data of all eligible studies was extracted on to a standardized abstraction sheet. Data about baseline population characteristics, type of intervention, study design and outcome was extracted. Our primary outcome was seizures.


RESULTS
The literature search identified 2489 unduplicated papers. Of these 2456 papers were excluded by reading the abstracts and titles. Another 25 papers were excluded after reading their complete text. We selected 8 papers which comprised of 2 RCTs and 6 observational studies. The pooled estimate's Odds Ratio 1.12 (95% CI = 0.34, 3.64) demonstrated no superiority of either drug at preventing the occurrence of early seizures. In a subset analysis of studies in which follow up for seizures lasted either 3 or 7 days, the effect estimate remained insignificant with an odds ratio of 0.96 (95% CI = 0.34, 2.76). Similarly, 2 trials reporting seizure incidence at 6 months also had insignificant pooled results while comparing drug efficacy. The pooled odds ratio was 0.96 (95% CI = 0.24, 3.79).


CONCLUSIONS
Levetiracetam and Phenytoin demonstrate equal efficacy in seizure prevention after brain injury. However, very few randomized controlled trials (RCTs) on the subject were found. Further evidence through a high quality RCT is highly recommended.
Department of Surgery, Aga Khan University, Karachi, Pakistan.
Syed Nabeel
SN
Zafar
Abdul Ahad
AA
Khan
Asfar Ayaz
AA
Ghauri
Muhammad Shahzad
MS
Shamim
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000188:drug therapy* / Q000453:epidemiology*; D015984:Causality; D015897:Comorbidity; D003292:Convulsants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000627:therapeutic use*; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015995:Prevalence; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome
D003292:Convulsants; D000077287:Levetiracetam; D010672:Phenytoin; D010889:Piracetam