title: Changing trends in the use of seizure prophylaxis after traumatic brain injury: a shift from phenytoin to levetiracetam.
abstract: OBJECTIVE
  Current guidelines for traumatic brain injury (TBI) recommend antiepileptic drugs (AEDs) for 7 days after injury to decrease posttraumatic seizure risk. Phenytoin decreases seizure risk 73% vs placebo during this time. Levetiracetam (LEV) is an alternative; however, no published data validate comparable efficacy. Our objective was to evaluate seizure incidence 7 days after TBI in patients treated with phenytoin (PHT) vs LEV and to characterize practice of AED selection.
  
  
  METHODS
  A retrospective observational study was conducted using a Trauma Registry (Collector Trauma Registry; Digital Innovation, Inc, Forrest Hill, Md) to evaluate patients with TBI. Patients with an initial Head/Neck Abbreviated Injury Scale score of 3 or higher and a Glasgow Coma Scale of 8 or less were included.
  
  
  RESULTS
  Of 109 patients, 89 received PHT, and 20, LEV. Two patients experienced posttraumatic seizure, 1 in each group. Sixty-eight patients survived to hospital discharge; 65% received prophylactic AED greater than 7 days. Ninety-eight percent of 81 patients admitted between 2000 and 2007 received PHT, whereas 64% of 28 patients admitted between 2008 and 2010 received LEV.
  
  
  CONCLUSIONS
  Only 2 patients experienced posttraumatic seizure after receiving AED, indicating low incidence. Most surviving to hospital discharge received AED prophylaxis greater than 7 days despite guideline recommendations. After approval of intravenous LEV, a trend favoring LEV was observed.
authors.affiliation: Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD 21287, USA. Electronic address: rkruer1@jhmi.edu.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Kruer
authors.forename: Lindsay H
authors.initials: LH
authors.lastname: Harris
authors.forename: Haley
authors.initials: H
authors.lastname: Goodwin
authors.forename: Joshua
authors.initials: J
authors.lastname: Kornbluth
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Thomas
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Slater
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications*; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000627:therapeutic use*; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010672:Phenytoin; D010889:Piracetam
keywords: Levetiracetam; Phenytoin; Seizure; Seizure prophylaxis; Traumatic brain injury