A prospective multicenter comparison of levetiracetam versus phenytoin for early posttraumatic seizure prophylaxis

Inaba, Kenji; Menaker, Jay; Branco, Bernardino C.; Gooch, Jonathan; Okoye, Obi; Herrold, Joe; Scalea, Thomas M.; DuBose, Joseph J.; Δημητριάδης, Δημήτριος

doi:10.1097/ta.0b013e3182826e84

Cited by 124 publications

(83 citation statements)

References 16 publications

(17 reference statements)

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“…7,8,13,14,19,22 Even with this benefit, levetiracetam may not be used as commonly due to its higher cost relative to phenytoin. 13 Most patients received seizure prophylaxis within 24 hours of hospital admission and over half received the first dose of medication in the prehospital or ED setting, early in severe TBI care. This is important because studies have reported that first posttraumatic seizures are common within 24 hours of injury.…”

Section: Discussionmentioning

confidence: 99%

“…Levetiracetam has only been researched as a potential option for seizure prophylaxis, 7,8,13,14,19 and initial studies have found it as effective as phenytoin but without similar side effects or the need to check drug levels in the blood. 7,8,13,14,19,22 Even with this benefit, levetiracetam may not be used as commonly due to its higher cost relative to phenytoin. 13 Most patients received seizure prophylaxis within 24 hours of hospital admission and over half received the first dose of medication in the prehospital or ED setting, early in severe TBI care.…”

Section: Discussionmentioning

confidence: 99%

“…13,18,22 Early seizure prophylaxis may be associated with a reduced incidence of early posttraumatic seizures which may lead to less secondary neurological insult and better postdischarge outcomes. Observational studies suggest that decreased posttraumatic seizures may have a survival benefit in patients treated with phenytoin in the acute phase.…”

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confidence: 99%

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Variation in seizure prophylaxis in severe pediatric traumatic brain injury

Ostahowski

Kannan²,

Wainwright

et al. 2016

PED

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OBJECTIVE Posttraumatic seizure is a major complication following traumatic brain injury (TBI). The aim of this study was to determine the variation in seizure prophylaxis in select pediatric trauma centers. The authors hypothesized that there would be wide variation in seizure prophylaxis selection and use, within and between pediatric trauma centers. METHODS In this retrospective multicenter cohort study including 5 regional pediatric trauma centers affiliated with academic medical centers, the authors examined data from 236 children (age < 18 years) with severe TBI (admission Glasgow Coma Scale score ≤ 8, ICD-9 diagnosis codes of 800.0–801.9, 803.0–804.9, 850.0–854.1, 959.01, 950.1–950.3, 995.55, maximum head Abbreviated Injury Scale score ≥ 3) who received tracheal intubation for ≥ 48 hours in the ICU between 2007 and 2011. RESULTS Of 236 patients, 187 (79%) received seizure prophylaxis. In 2 of the 5 centers, 100% of the patients received seizure prophylaxis medication. Use of seizure prophylaxis was associated with younger patient age (p < 0.001), inflicted TBI (p < 0.001), subdural hematoma (p = 0.02), cerebral infarction (p < 0.001), and use of electroencephalography (p = 0.023), but not higher Injury Severity Score. In 63% cases in which seizure prophylaxis was used, the patients were given the first medication within 24 hours of injury, and 50% of the patients received the first dose in the prehospital or emergency department setting. Initial seizure prophylaxis was most commonly with fosphenytoin (47%), followed by phenytoin (40%). CONCLUSIONS While fosphenytoin was the most commonly used medication for seizure prophylaxis, there was large variation within and between trauma centers with respect to timing and choice of seizure prophylaxis in severe pediatric TBI. The heterogeneity in seizure prophylaxis use may explain the previously observed lack of relationship between seizure prophylaxis and outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Variation in seizure prophylaxis in severe pediatric traumatic brain injury

Ostahowski

Kannan²,

Wainwright

et al. 2016

PED

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“…Mahajan et al reported a case of rapidly progressing distal limb ischemia resulting in compartment syndrome with arterial occlusion and thrombosis [31]. Finally, alternative drug regimens should be considered in situations in which efficacy has been shown to be non-inferior to phenytoin [2,10,60]. Any intravenous insertion sites should be monitored closely for pain, signs of extravasation, discoloration, or changes in perfusion and documented thoroughly [1,3].…”

Section: Preventionmentioning

confidence: 99%

Purple Glove Syndrome after Phenytoin or Fosphenytoin Administration: Review of Reported Cases and Recommendations for Prevention

2015

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The aim of our study was to identify all previously reported cases of phenytoin-or fosphenytoin-associated purple glove syndrome (PGS) and summarize the most current understanding of the pathophysiology, clinical presentation, diagnosis, and treatment of the disease. We searched the English language references from MEDLINE, EMBASE, CINA HL, TOXNET, and gray literature that featured one or more case descriptions of phenytoin-or fosphenytoin-associated PGS after administration and provided information on the clinical setting of the event and associated outcome(s). Descriptive statistics were employed to summarize relevant facts about the cases. We identified 82 unique cases of parenteral phenytoin-associated PGS and 5 cases of fosphenytoinassociated PGS that were published from 1984 to 2015. Additionally, we found two cases of PGS associated with oral formulation of phenytoin published from 1999 to 2015. The spectrum of tissue injury ranged from mild local cutaneous reactions around the infusion site to frank limb ischemia. Just over a half of cases reported symptoms after one dose of IV phenytoin. Pathologic findings included evidence for microvascular thrombosis and possible microvascular or subclinical extravasation as a contributing mechanism. Dopper ultrasound and conventional angiography were used in some patients to identify arterial or venous thrombosis. Various treatments were documented including the use of supportive care such as limb elevation and heat or cold application, utilization of systemic antibiotics, anticoagulants, or vasodilators, and local infiltration of hyaluronidase, heparin, or other compounds. In a small number of patients, invasive interventions such as regional anesthesia, thrombectomy, fasciotomy, and debridement were described. Time to resolution varied from days to weeks. Resolution of PGS without deficits was documented in the majority of cases. Skin changes followed by sensory and motor deficits were described in 16, 6, and 5 cases, respectively. Four patients underwent skin grafting and eight patients required limb amputation. Death as a result of PGS was documented in two patients. PGS associated with oral and injectable phenytoin or parenteral fosphenytoin has been documented in the literature and sometimes includes significant vascular thrombosis and potentially limbthreatening ischemia. Avoidance of small hand veins, adherence to recommended IV administration guidelines and monitoring of the infusion site for reactions should be considered to decrease the morbidity of IV phenytoin or fosphenytoin use. Patients with PGS and evidence of decreased distal perfusion should undergo prompt vascular imaging and potential intervention to avoid ischemic sequelae. Alternative anticonvulsant drugs should be considered in patients at risk for PGS when possible. hemorrhage, and secondary seizure disorder presented with partial left-sided motor seizure progressing to generalized tonic-clonic activity in the emergency department. After treatment with 4 mg of intravenous (IV) loraz...

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“…Patients with severe TBI should receive phenytoin or levetiracetam for post-traumatic seizures [27][28][29] . Other risk factors for seizures are listed in Table 4.…”

Section: Adjunctive Therapiesmentioning

confidence: 99%