Early Seizure Prophylaxis in Traumatic Brain Injuries Revisited: A Prospective Observational Study

Khor, Desmond; Wu, Jinglan; Hong, Quanqiu; Benjamin, Elizabeth; Xiao, Shaobo; Inaba, Kenji; Δημητριάδης, Δημήτριος

doi:10.1007/s00268-017-4373-0

Cited by 21 publications

(15 citation statements)

References 29 publications

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“…The incidence of EPTS ranges from 0.4% to 26.7%, depending on study population and methods for seizure detection 9–12 . They are associated with increased intracranial pressure, worsening cerebral edema, and metabolic crisis 13,14 .…”

Section: Introductionmentioning

confidence: 99%

Early post‐traumatic seizures in hospitalized patients with traumatic brain injury

Sødal

Storvig

Tverdal

et al. 2022

Acta Neuro Scandinavica

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Section: Introductionmentioning

confidence: 99%

Early post‐traumatic seizures in hospitalized patients with traumatic brain injury

Sødal

Storvig

Tverdal

et al. 2022

Acta Neuro Scandinavica

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“…Although several therapeutic targets have been ascribed for levetiracetam, it is clear that it modulates the synaptic vesicle glycoprotein 2A, with consequent reduction of the release of synaptic excitatory neurotransmitters, restoring the balance between inhibitory and excitatory synaptic activities [ 3 , 4 , 5 , 6 , 7 ]. This unique mechanism of action may be linked with the usefulness of levetiracetam for the management of status epilepticus in pediatric and adult patients [ 8 , 9 , 10 , 11 , 12 ], prophylaxis of seizures from post-traumatic brain injury [ 13 , 14 , 15 , 16 , 17 ], neuropathic pain [ 18 ], and some psychiatric pathologies [ 19 ]. Moreover, its safety profile and linear pharmacokinetics, together with its low ability to cross the placental barrier, make levetiracetam a first-line option in pregnant women with epilepsy [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetic Monitoring of Levetiracetam in Portuguese Refractory Epileptic Patients: Effect of Gender, Weight and Concomitant Therapy

et al. 2020

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Levetiracetam is a second-generation antiepileptic drug, widely used in the treatment of focal and generalized epilepsy due to its pharmacokinetic and safety profiles. Its pharmacokinetic monitoring is ascribed as useful to personalize its dosing regimen. The aim of the present study was to describe, for the first time, the pharmacokinetics of levetiracetam in Portuguese refractory epileptic patients. Therefore, a retrospective study was carried out on 65 Portuguese refractory epileptic patients (pharmacokinetic study: 48; validation study: 17) admitted to the Refractory Epilepsy Centre of the Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. The pharmacokinetic parameters of levetiracetam were estimated by applying a one-compartment model with first-order absorption and elimination analysis. Male patients showed higher distribution volume (Vd/F) and oral clearance (CL/F) than female patients (median Vd/F: 52.40 L in males and 38.60 L in females, p = 0.011; median CL/F: 4.71 L/h in males and 3.91 L/h in females, p = 0.028). Higher values of Vd/F (p = 0.026) and CL/F (p = 0.003) were also found in overweight patients relative to normal weight and obese patients. Carbamazepine was the co-administered antiepileptic drug that mostly affected the pharmacokinetics of levetiracetam, increasing both Vd/F (61.30 L with carbamazepine and 39.10 L without carbamazepine, p = 0.007) and CL/F (6.71 L/h with carbamazepine and 3.91 L/h without carbamazepine, p < 0.001). The pharmacokinetics of levetiracetam was affected by gender, body mass index, and co-administration of carbamazepine. This study highlights the impact of several factors on the CL/ and Vd/F of levetiracetam when administered to refractory epileptic patients. The importance of its pharmacokinetic monitoring in clinical pharmacy stands out, thereby enabling the optimization of antiepileptic drug therapy.

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“…An additional 53 articles were excluded as these did not meet the eligibility criteria of this meta-analysis. Finally, 25 articles with a total sample size of 6,466 cases were included in the network meta-analysis, including seven randomized controlled trials ( Young et al, 1983a ; Young et al, 1983b ; Temkin et al, 1990 ; Temkin et al, 1999 ; Szaflarski et al, 2010 ; Khan et al, 2016 ; Younus et al, 2018 ), four prospective studies ( Jones et al, 2008 ; Inaba et al, 2013 ; Gabriel and Rowe, 2014 ; Khor et al, 2018 ), 13 retrospective studies ( Wohns and Wyler, 1979 ; Servit and Musil, 1981 ; Ma et al, 2010 ; Debenham et al, 2011 ; Caballero et al, 2013 ; Kruer et al, 2013 ; Bhullar et al, 2014 ; Javed et al, 2016 ; Zangbar et al, 2016 ; Hazama et al, 2018 ; Kwon et al, 2019 ; Harris et al, 2020 ; Nguyen et al, 2021 ), and one non-randomized trial ( Klein et al, 2012 ) as shown in Figure 1 . The characteristics of the study design, interventions, and sample size for each treatment group are summarized in ( Tables 1 , 2 ).…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of antiseizure medications therapy in preventing seizures in brain injury patients: A network meta-analysis

Huo

et al. 2022

Front. Pharmacol.

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Purpose: To explore the effectiveness of different anti-seizure medications in preventing early and late post-traumatic epilepsy (PTE). The efficacy, treatment-related side-effects, and mortality of the different treatments were compared using a ranking model to identify the optimal treatment. Methods: A comprehensive literature search was performed using Pubmed, Medline, Embase, and Cochrane library databases. All relevant published articles up to 10 March 2022 were evaluated. The quality of the extracted data was assessed using either the Cochrane risk of bias tool or the Newcastle-Ottawa scale. The primary outcome measures were early or late post-traumatic seizures. The secondary outcome measures were mortality, treatmentrelated adverse effects, length of hospital stay, and length of stay within the intensive care unit (ICU).Results: A total of seven randomized controlled trials and 18 non-randomized controlled trials were included in this network meta-analysis. The trials included six interventions: Phenytoin (PHT)+phenobarbital (PB), levetiracetam (LEV), PHT, PHT-LEV, lacosamide (LCM), and valproate (VPA). All interventions except VPA significantly reduced the rate of early PTE in TBI patients compared with the placebo. Seven studies reported the impact of four treatments (PHT + PB, LEV, PHT, VPA) on late seizures and showed a significant reduction in the incidence of late seizures in patients with TBI

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Early Seizure Prophylaxis in Traumatic Brain Injuries Revisited: A Prospective Observational Study

Abstract: The present study failed to show any benefit of routine early seizure prophylaxis following blunt TBI. This practice should be reexamined in a large randomized clinical study.

Cited by 21 publications

References 29 publications

Early post‐traumatic seizures in hospitalized patients with traumatic brain injury

Early post‐traumatic seizures in hospitalized patients with traumatic brain injury

Pharmacokinetic Monitoring of Levetiracetam in Portuguese Refractory Epileptic Patients: Effect of Gender, Weight and Concomitant Therapy

Effectiveness of antiseizure medications therapy in preventing seizures in brain injury patients: A network meta-analysis

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