title: Should Levetiracetam or Phenytoin Be Used for Posttraumatic Seizure Prophylaxis? A Systematic Review of the Literature and Meta-analysis.
abstract: Posttraumatic seizure (PTS) is a significant complication of traumatic brain injury (TBI).
  
  
  
  To perform a systematic review and meta-analysis to compare levetiracetam with phenytoin for seizure prophylaxis in patients diagnosed with severe TBI.
  
  
  
  An inclusive search of several electronic databases and bibliographies was conducted to identify scientific studies that compared the effect of levetiracetam and phenytoin on PTS. Independent reviewers obtained data and classified the quality of each article that met inclusion criteria. A random effects meta-analysis was then completed.
  
  
  
  During June and July 2015, a systematic literature search was performed that identified 6097 articles. Of these, 7 met inclusion criteria. A random-effects meta-analysis was performed. A total of 1186 patients were included. The rate of seizure was 35 of 654 (5.4%) in the levetiracetam cohort and 18 of 532 (3.4%) in the phenytoin cohort. Our meta-analysis revealed no change in the rate of early PTS with levetiracetam compared with phenytoin (relative risk, 1.02; 95% confidence interval, 0.53-1.95; P = .96).
  
  
  
  The lack of evidence on which antiepileptic drug to use in PTS is surprising given the number of patients prescribed an antiepileptic drug therapy for TBI. On the basis of currently available Level III evidence, patients treated with either levetiracetam or phenytoin have similar incidences of early seizures after TBI.
  
  
  
  ADE, adverse drug eventAED, antiepileptic drugCI, confidence intervalOR, odds ratioPTS, posttraumatic seizureTBI, traumatic brain injury.
authors.affiliation: *Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee; ‡Department of Neurosurgery, Temple University School of Medicine, Philadelphia, Pennsylvania; §University of Memphis, Department of Psychology and Neuroscience, Memphis, Tennessee; ¶Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas; ‖Department of Neurosurgery, Dartmouth-Hitchcock Hospital, Lebanon, New Hampshire; #Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; **Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts; ‡‡Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee.
authors.forename: Nickalus R
authors.initials: NR
authors.lastname: Khan
authors.forename: Matthew A
authors.initials: MA
authors.lastname: VanLandingham
authors.forename: Tamara M
authors.initials: TM
authors.lastname: Fierst
authors.forename: Caroline
authors.initials: C
authors.lastname: Hymel
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hoes
authors.forename: Linton T
authors.initials: LT
authors.lastname: Evans
authors.forename: Rory
authors.initials: R
authors.lastname: Mayer
authors.forename: Fred
authors.initials: F
authors.lastname: Barker
authors.forename: Paul
authors.initials: P
authors.lastname: Klimo
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000628:therapy; D006801:Humans; D000077287:Levetiracetam; D010672:Phenytoin / Q000627:therapeutic use*; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012640:Seizures / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010672:Phenytoin; D010889:Piracetam