Levetiracetam versus phenytoin for seizure prophylaxis in severe traumatic brain injury

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Current standard of care for patients with severe traumatic brain injury (TBI) is prophylactic treatment with phenytoin for 7 days to decrease the risk of early posttraumatic seizures. Phenytoin alters drug metabolism, induces fever, and requires therapeutic-level monitoring. Alternatively, levetiracetam (Keppra) does not require serum monitoring or have significant pharmacokinetic interactions. In the current study, the authors compare the EEG findings in patients receiving phenytoin with those receiving levetiracetam monotherapy for seizure prophylaxis following severe TBI.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Data were prospectively collected in 32 cases in which patients received levetiracetam for the first 7 days after severe TBI and compared with data from a historical cohort of 41 cases in which patients received phenytoin monotherapy. Patients underwent 1-hour electroencephalographic (EEG) monitoring if they displayed persistent coma, decreased mental status, or clinical signs of seizures. The EEG results were grouped into normal and abnormal findings, with abnormal EEG findings further categorized as seizure activity or seizure tendency.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Fifteen of 32 patients in the levetiracetam group warranted EEG monitoring. In 7 of these 15 cases the results were normal and in 8 abnormal; 1 patient had seizure activity, whereas 7 had seizure tendency. Twelve of 41 patients in the phenytoin group received EEG monitoring, with all results being normal. Patients treated with levetiracetam and phenytoin had equivalent incidence of seizure activity (p = 0.556). Patients receiving levetiracetam had a higher incidence of abnormal EEG findings (p = 0.003).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Levetiracetam is as effective as phenytoin in preventing early posttraumatic seizures but is associated with an increased seizure tendency on EEG analysis.</jats:p></jats:sec>

Use of enteral levetiracetam for prophylaxis of early post traumatic seizures

“…However several studies have compared the two drugs. In 2008, Jones et al compared the two drugs in a cohort of severe traumatic brain injury (9). Statistically, no significant difference was found between the two drugs in terms of seizure control but the incidence of abnormal EEG was higher in the levetiracetam group in their study (9).…”

“…Recently, the effectiveness of levetiracetam has been studied in the prophylaxis of post-traumatic seizures (9) and seizures following trauma and subarachnoid hemorrhage (17). Jones et al (9) have compared the drugs in severe traumatic brain injury and did not find a statistically significant difference between the two drugs. The drug has more than 95% bioavailability and is not affected by co-ingestion (9,11).…”

“…Jones et al (9) have compared the drugs in severe traumatic brain injury and did not find a statistically significant difference between the two drugs. The drug has more than 95% bioavailability and is not affected by co-ingestion (9,11). In an experimental study on healthy subjects, single doses of levetiracetam 1,500 mg administered as a 15-minute IV infusion and as oral tablets were shown to be bioequivalent (14).…”

Протиепілептична, Нейропротективна Та антигіпералгічна Дія Леветирацетаму

“…Эффективность и переносимость леветирацетама в комплексной терапии у пациентов с неконтролируе-мыми генерализованными тонико-клоническими су-дорогами при идиопатической генерализованной эпи-лепсии была изучена Berkovic с коллегами [11]. У 56,5 % пациентов было отмечено снижение частоты генерали-зованных тонико-клонических припадков в неделю на фоне лечения по сравнению с плацебо-терапией, при которой среднее снижение частоты приступов составля-ло 28,2 %.…”

“…В сравнительном исследовании монотера-пии леветирацетамом и фенитоином для профилактики припадков при тяжелой черепно-мозговой травме Jones с соавторами [11] пришли к выводу, что леветирацетам столь же эффективен, как и фенитоин, для предотвра-щения ранних посттравматических приступов. Однако монотерапия леветирацетамом была связана с увеличе-нием частоты патологических электроэнцефалографи-ческих данных.…”