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

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

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Current guidelines for traumatic brain injury (TBI) recommend antiepileptic drugs (AEDs) for 7 days after injury to decrease posttraumatic seizure risk. Phenytoin decreases seizure risk 73% vs placebo during this time. Levetiracetam (LEV) is an alternative; however, no published data validate comparable efficacy. Our objective was to evaluate seizure incidence 7 days after TBI in patients treated with phenytoin (PHT) vs LEV and to characterize practice of AED selection. Methods: A retrospective observational study was conducted using a Trauma Registry (Collector Trauma Registry; Digital Innovation, Inc, Forrest Hill, Md) to evaluate patients with TBI. Patients with an initial Head/Neck Abbreviated Injury Scale score of 3 or higher and a Glasgow Coma Scale of 8 or less were included. Results: Of 109 patients, 89 received PHT, and 20, LEV. Two patients experienced posttraumatic seizure, 1 in each group. Sixty-eight patients survived to hospital discharge; 65% received prophylactic AED greater than 7 days. Ninety-eight percent of 81 patients admitted between 2000 and 2007 received PHT, whereas 64% of 28 patients admitted between 2008 and 2010 received LEV. Conclusion: Only 2 patients experienced posttraumatic seizure after receiving AED, indicating low incidence. Most surviving to hospital discharge received AED prophylaxis greater than 7 days despite guideline recommendations. After approval of intravenous LEV, a trend favoring LEV was observed.

Original languageEnglish (US)
Pages (from-to)883.e9-883.e13
JournalJournal of Critical Care
Volume28
Issue number5
DOIs
StatePublished - Oct 2013

Keywords

  • Levetiracetam
  • Phenytoin
  • Seizure
  • Seizure prophylaxis
  • Traumatic brain injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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