title: Levetiracetam versus (fos)phenytoin for seizure prophylaxis in pediatric patients with intracranial hemorrhage.
abstract: OBJECTIVE
  Seizure prophylaxis is used in a variety of conditions, including supratentorial intracranial hemorrhage (ICH). In adults, studies have demonstrated phenytoin as the drug of choice for seizure prophylaxis; in children, levetiracetam is often provided due to its favorable side effect profile and pharmacokinetics. This study evaluated the difference in efficacy between these treatment options.
  
  
  METHODS
  This retrospective review included 126 patients between 1 month and 17 years of age with acute supratentorial ICH; all received seizure prophylaxis. Demographic data and outcome assessments were compared.
  
  
  RESULTS
  Seizure prophylaxis was provided with (fos)phenytoin in 40 children, levetiracetam in 61 children, and both drugs in 25 patients. Baseline characteristics of the treatment groups were similar, except that more patients treated with (fos)phenytoin had seizures on presentation. Patients treated solely with (fos)phenytoin had a higher probability of early seizures (within 7 days of ICH) compared with those treated only with LVT, controlling for relevant variables including seizures on presentation (OR 24.6, p = 0.002). Patients treated with (fos)phenytoin were more likely to need additional antiepileptic drugs for seizure control (p = 0.005). There was no significant difference in the incidence of late seizures (> 7 days after ICH) (p = 0.265). Adverse events necessitating a change in therapy were uncommon.
  
  
  CONCLUSIONS
  Levetiracetam is a reasonable alternative to (fos)phenytoin for prophylaxis of early posthemorrhagic seizures. Levetiracetam and (fos)phenytoin are well tolerated in children. Prospective studies are needed to determine superiority, optimal dosing, and impact on long-term outcomes.
authors.affiliation: Departments of Neurology and.
authors.forename: Seema
authors.initials: S
authors.lastname: Bansal
authors.forename: Dan
authors.initials: D
authors.lastname: Blalock
authors.forename: Tewodros
authors.initials: T
authors.lastname: Kebede
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Dean
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Carpenter
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D020300:Intracranial Hemorrhages / Q000150:complications*; D000077287:Levetiracetam; D008297:Male; D010672:Phenytoin / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use*; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011322:Primary Prevention / Q000379:methods*; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010672:Phenytoin; C043114:fosphenytoin; D010889:Piracetam