Early Post-traumatic Seizure Occurrence in Pediatric Patients Receiving Levetiracetam Prophylaxis With Severe Traumatic Brain Injury

Abstract

OBJECTIVE Although levetiracetam is used for the prevention of early Post-traumatic seizures (EPTS) after traumatic brain injury (TBI), limited data exist describing the incidence of seizures in pediatric patients receiving levetiracetam prophylaxis. The objective of this research is to evaluate the prevalence of EPTS in children given prophylactic levetiracetam after severe TBI. METHODS This study was conducted at a Level 1 pediatric trauma center and included pediatric patients with severe TBI who received levetiracetam for EPTS prophylaxis. Demographics and clinical information were retrospectively collected and evaluated. The primary outcome was prevalence of clinical or electrographic seizures within 7 days of initial injury as noted in the EMR. RESULTS In 4 of 44 patients (9%), seizures developed despite levetiracetam prophylaxis. Concurrent use of other medications with antiepileptic properties was common (91%). There were no differences in demographic or baseline clinical characteristics between the group of patients experiencing seizures and those who did not. However, craniotomy was significantly more common in the seizure group (75% vs. 18%, p = 0.03). CONCLUSIONS Children receiving prophylaxis with levetiracetam after severe TBI had a lower incidence of seizures (9%) than had previously been reported in the literature (18%). Given the limited literature available supporting the use of levetiracetam for the prevention of EPTS in children experiencing severe TBI, further study is needed to support routine use.

Early posttraumatic seizures in pediatric traumatic brain injury: a multicenter analysis

“…8 Prophylactic AEDs have not been proven to be protective against EPTS, and their use is still debated. 6,8,19 Given the lack of well-controlled studies, the most recent Brain Trauma Foundation guidelines recommended only level III evidence for the use of prophylactic AEDs in pediatric patients with TBI. 4,6,8,20,21 Although the proportion of children with EPTS among those who received prophylactic AEDs was smaller than the proportion with EPTS among those who did not receive prophylactic AEDs (17.5% vs 26.0%, p = 0.158), we were not able to establish the protective effect of prophylactic AEDs given our retrospective study design.…”

Clinical Pharmacology of Levetiracetam in Infants and Children

“…In children, aged 0.5 to 14 years, levetiracetam is rapidly absorbed following oral dosing and the mean total body clearance and distribution volume are 1.04 L/h and 12.1 L, respectively [25]. The prophylaxis with levetiracetam has been studied in infants and children [26][27][28][29]. Levetiracetam is effective as flunarizine in the prophylaxis of migraine in paediatric patients [26], levetiracetam and phenytoin have similar effectiveness for prevention of seizure induced by busulfan [27], levetiracetam and (fos) phenytoin are similarly effective in preventing early post-haemorrhagic seizures in infants and children [28], and prophylactic levetiracetam reduces the incidence of seizures in children after severe traumatic brain injury [29].…”

“…The prophylaxis with levetiracetam has been studied in infants and children [26][27][28][29]. Levetiracetam is effective as flunarizine in the prophylaxis of migraine in paediatric patients [26], levetiracetam and phenytoin have similar effectiveness for prevention of seizure induced by busulfan [27], levetiracetam and (fos) phenytoin are similarly effective in preventing early post-haemorrhagic seizures in infants and children [28], and prophylactic levetiracetam reduces the incidence of seizures in children after severe traumatic brain injury [29]. The treatment of infants and children with levetiracetam has been extensively studied [30][31][32][33][34][35][36][37][38].…”

“…Levetiracetam is a reasonable alternative to (fos) phenytoin for prophylaxis of early post-haemorrhagic seizures in infants and children [28]. Children receiving prophylaxis with levetiracetam after severe traumatic brain injury have a lower incidence of seizures of 9% [29].…”

Post-traumatic depressions in children and adolescents

“…В одному з досліджень продемонстрована ефективність застосування леветирацетаму для профілактики виникнення судом посттравматичного генезу, встановлено значно нижчу поширеність випадків судом після профілактичної терапії (9 %) порівняно з подібними когортами, дослідженими іншими авторами [39]. Застосування леветирацетаму не супроводжувалося побічними ефектами, пов'язаними з конкурентною взаємодією з іншими лікарськими засобами, виявилося значно безпечнішим, краще переносилося порівняно з фенітоїном [63].…”