Lauren Albertina, PharmD, BCCCP,
Float Critical Care Clinical Pharmacy Specialist
Inova Fairfax Hospital
Falls Church, VA
Disclosure information not submitted.
.jpg "April Finnigan, BCCCP, PharmD photo")
April Finnigan, BCCCP, PharmD
Critical Care Clinical Pharmacy Specialist
Inova Fairfax Hospital
Falls Church, Virginia
Disclosure information not submitted.
Jenna Smith, PharmD, BCCCP
Medical-Surgical ICU Clinical Pharmacy Specialist
Inova Fairfax Medical Campus
Falls Church, Virginia, United States
Disclosure information not submitted.
Title: Low-dose Levetiracetam versus Phenytoin for Early Seizure Prophylaxis after Traumatic Brain Injury
Introduction: Brain Trauma Foundation Guidelines recommend phenytoin (PHE) for the prevention of early posttraumatic seizures (PTS). Levetiracetam (LEV) has gained popularity in recent years for this indication owing to its lack of serum drug monitoring, ease of administration, minimal drug interactions, and fewer reported adverse effects when compared to PHE. However, the effective dose of LEV remains unclear. The purpose of this study was to compare the incidence of early PTS in patients receiving either low-dose LEV (500 mg twice daily) or PHE for the first seven days after traumatic brain injury (TBI).
Methods: A retrospective chart review was conducted on adult TBI patients receiving either low-dose LEV or PHE for the prevention of early PTS between January 2016 and September 2020. TBI patients were identified using diagnosis-related group codes.
Results: 200 patients were evaluated with 100 patients in each group. Overall, most patients (98%) sustained blunt TBIs. The LEV cohort had a lower median Glasgow Coma Scale (GCS) score on admission (13 vs 15), in addition to a lower median best GCS score (14 vs 15) and worst GCS score (8 vs 13) within 24 hours of admission. The LEV group more frequently received hyperosmolar agents (47% vs 21%) and underwent neurosurgical intervention (35% vs 18%) when compared to the PHE group. The incidence of clinical seizures occurred in a fewer proportion of patients receiving LEV (1% vs 8%, p = 0.035). While there was an increased median intensive care unit (ICU) length of stay (LOS) in the LEV group (6 vs 3 days, p < 0.001), there was no significant difference in median hospital LOS between groups (7 vs 5 days, p = 0.067).
Conclusions: Low-dose LEV demonstrated a similar rate of early PTS in comparison to PHE when used for the first seven days after TBI. Differences in ICU and hospital LOS were more likely attributable to the LEV cohort’s severity of injury, as measured by lower median GCS scores within the first 24 hours of admission in addition to an increased need for hyperosmolar and neurosurgical intervention. Larger, prospective studies involving more patients with penetrating TBIs would be necessary in order to validate observations made in this study.