Changing trends in the use of seizure prophylaxis after traumatic brain injury: A shift from phenytoin to levetiracetam

Kruer, Rachel; Harris, Lindsay; Goodwin, Haley; Kornbluth, Joshua; Thomas, Katherine P.; Slater, Leigh A.; Haut, Elliott R.

doi:10.1016/j.jcrc.2012.11.020

Cited by 76 publications

(47 citation statements)

References 7 publications

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“…A recent increase in the use of levetiracetam for seizure prophylaxis has also been noted in adults (27). Several factors may underlie the growing use of levetiracetam, including the availability of an intravenous formulation, favorable side effect profile and minimal medication interactions.…”

Section: Discussionmentioning

confidence: 99%

Variation in Anticonvulsant Selection and Electroencephalographic Monitoring Following Severe Traumatic Brain Injury in Children—Understanding Resource Availability in Sites Participating in a Comparative Effectiveness Study

Kurz

Poloyac

Abend

et al. 2016

Pediatric Critical Care Medicine

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Objective Early post-traumatic seizures (PTS) may contribute to worsened outcomes after traumatic brain injury (TBI). Evidence to guide the evaluation and management of early PTS in children is limited. We undertook a survey of current practices of continuous electroencephalographic monitoring (cEEG), seizure prophylaxis and the management of early PTS to provide essential information for trial design and the development of PTS management pathways. Design Surveys were sent to site principal investigators at all 43 sites participating in the ADAPT (Approaches and Decisions in Acute Pediatric TBI) trial at the time of the survey. Surveys consisted of 12 questions addressing strategies to (i) implement cEEG monitoring, (ii) PTS prophylaxis, (iii) treat acute PTS, (iv) treat status epilepticus (SE) and refractory status epilepticus (RSE) and (v) monitor anti-seizure drug levels. Setting Institutions comprised a mixture of free-standing children’s hospitals and university medical centers across the United States and Europe. Measurements and Main Results cEEG monitoring was available in the pediatric intensive care unit in the overwhelming majority of clinical sites (98%); however, the plans to operationalize such monitoring for children varied considerably. A similar majority of sites report that administration of prophylactic anti-seizure medications is anticipated in children (93%), yet a minority reports that a specified protocol for treatment of PTS is in place (43%). Reported medication choices varied substantially between sites, but the majority of sites reported pentobarbital for RSE (81%). Presence of an treatment protocols for seizure prophylaxis, early PTS, post-traumatic SE and RSE was associated with decreased reported medications (all p < 0.05). Conclusions This study reports the current management practices for early PTS in select academic centers after pediatric severe TBI. The substantial variation in cEEG implementation, choice of seizure prophylaxis medications, and management of early PTS across institutions was reported, signifying areas of clinical uncertainty that will help provide for focused design of clinical trials. While sites with treatment protocols reported decreased number of medications for the scenarios described, completion of the ADAPT Trial will be able to determine if these protocols lead to decreased variability in medication administration in children at the clinical sites.

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Section: Discussionmentioning

confidence: 99%

Variation in Anticonvulsant Selection and Electroencephalographic Monitoring Following Severe Traumatic Brain Injury in Children—Understanding Resource Availability in Sites Participating in a Comparative Effectiveness Study

Kurz

Poloyac

Abend

et al. 2016

Pediatric Critical Care Medicine

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“…The selection process and reasons for exclusion are detailed in Figure 1. After applying the selection criteria, one RCT, two prospective cohort studies and six retrospective cohort studies were identified in the final analysis [15,20,[25][26][27][28][29][30][31]. …”

Section: Study Selectionmentioning

confidence: 99%

“…Information was obtained on mortality from four trials [20,[25][26][27]. There were 99 related deaths, of which 43 occurred in the LEV arm and 56 occurred in the PHT arm.…”

Section: Overall Mortalitymentioning

confidence: 99%

“…As a result, no evidence of publication bias was observed for the comparison, indicating that the results were statistically robust ( Figure 6). Jones et al [31] *** -*** 6/9 Szaflarski et al [20] *** ** *** 8/9 Taylor et al [29] *** ** ** 7/9 Murphy-Human et al [30] *** ** *** 8/9 Inaba et al [25] *** ** ** 7/9 Kruer et al [26] *** ** ** 7/9 Caballero et al [28] *** ** ** 7/9 Bansal et al [15] *** ** *** 8/9 Radic et al [27] *** ** *** 8/9…”

Section: Sensitivity Analysis and Publication Biasmentioning

confidence: 99%

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The safety and efficacy of levetiracetam versus phenytoin for seizure prophylaxis after traumatic brain injury: A systematic review and meta-analysis

Xu¹,

Shen²,

Shao

et al. 2016

Brain Injury

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“…These medications include fosphenytoin, valproic acid, levetiracetam, and lacosamide. For many years, phenytoin and then fosphenytoin were the initial AEDs used in patients with SDH, but in recent years levetiracetam has been used increasingly due to its favorable pharmacology and tolerability [60]. There are no controlled studies aimed specifically at addressing the role, duration of treatment, and type of AEDs used with SDH.…”

Section: Treatmentmentioning

confidence: 99%

Seizures in Subdural Hematoma

Shihabuddin

Hinduja

Yaghi

2015

Seizures in Cerebrovascular Disorders

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Changing trends in the use of seizure prophylaxis after traumatic brain injury: A shift from phenytoin to levetiracetam

Cited by 76 publications

References 7 publications

Variation in Anticonvulsant Selection and Electroencephalographic Monitoring Following Severe Traumatic Brain Injury in Children—Understanding Resource Availability in Sites Participating in a Comparative Effectiveness Study

Variation in Anticonvulsant Selection and Electroencephalographic Monitoring Following Severe Traumatic Brain Injury in Children—Understanding Resource Availability in Sites Participating in a Comparative Effectiveness Study

The safety and efficacy of levetiracetam versus phenytoin for seizure prophylaxis after traumatic brain injury: A systematic review and meta-analysis

Seizures in Subdural Hematoma

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