title: Long-term comparison of GOS-E scores in patients treated with phenytoin or levetiracetam for posttraumatic seizure prophylaxis after traumatic brain injury.
abstract: BACKGROUND
  Much debate exists on the optimal medication for posttraumatic seizure prophylaxis after traumatic brain injury (TBI). There is some evidence that levetiracetam (LEV) could be neuroprotective and provide long-term benefits in this patient population.
  
  
  OBJECTIVE
  The primary objective was to compare the Glasgow Outcome Scale-Extended (GOS-E) 6 months or more after severe TBI. Secondary end points were presence of early seizures (0 to 7 days post-TBI) or late seizures (8 days post-TBI to phone interview), use of anticonvulsant medication when interviewed, medication-related hospital complications, and a summary of phenytoin (PHT) and LEV dosing regimens.
  
  
  METHODS
  This was an IRB-approved, single-center, prospective cohort analysis. Patients were identified by cross-referencing a list of patients receiving LEV or PHT, with a list of patients with ICD-9 code consistent with TBI. After study inclusion, patients were contacted by telephone, and the GOS-E was administered. Data for secondary end points were gathered by retrospective chart review.
  
  
  RESULTS
  In all, 19 patients were included in the final analysis. There was no difference in the GOS-E score assessed ≥6 months after injury (5.07±1.69 vs 5.60±2.07, P=0.58). There was no difference in the secondary end points of early seizures (P=0.53) or late seizures (P=0.53). However, the PHT group experienced a higher rate of hospital days with recorded fever (0.20±0.22 vs 0±0; P=0.014).
  
  
  CONCLUSIONS
  Long-term functional outcome in patients who experienced a TBI was not affected by treatment with PHT or LEV; however, patients treated with PHT had a higher incidence of fever during hospitalization.
authors.affiliation: The University of Tennessee Medical Center Knoxville, TN, USA The University of Tennessee Health Science Center, College of Pharmacy, Knoxville, TN, USA.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Gabriel
authors.affiliation: The University of Tennessee Health Science Center, College of Pharmacy, Knoxville, TN, USA arowe@uthsc.edu.
authors.forename: A Shaun
authors.initials: AS
authors.lastname: Rowe
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D010672:Phenytoin / Q000627:therapeutic use*; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies; D012640:Seizures / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010672:Phenytoin; D010889:Piracetam
keywords: GOS-E; Glasgow Outcome Scale–Extended; Keppra; fosphenytoin; levetiracetam; phenytoin; post-traumatic seizure prophylaxis; seizure; traumatic brain injury