Mary Stewart Leatherwood, PharmD
PGY2 Critical Care Pharmacy Resident
Wake Forest Baptist Health
Winston Salem, North Carolina
Disclosure information not submitted.
Leslie Hamilton, BCCCP, BCPS, PharmD
Associate Professor
University of Tennessee College of Pharmacy
Knoxville, Tennessee
Disclosure information not submitted.
Jacob Barber, PharmD Candidate 2022
PharmD Candidate
University of Tennessee College of Pharmacy, United States
Disclosure information not submitted.
Shaun Rowe, PharmD, MS, BCCCP, FNCS
Associate Professor
University of Tennessee College of Pharmacy, United States
Disclosure information not submitted.
Title: Levetiracetam Use After Spontaneous Intracerebral Hemorrhage
Introduction: Approximately 16% of patients with spontaneous intracerebral hemorrhage (ICH) experience early clinical seizures. Current literature is conflicting regarding the benefit of prophylactic antiepileptic agents (AED) in these patients, and current ICH guidelines do not recommend use (level of evidence IIIC). Most studies have primarily assessed phenytoin, which has fallen out of favor due to side effects and drug interactions. Levetiracetam is better tolerated and commonly used as a prophylactic AED, however, studies are limited. The purpose of this study was to assess the incidence of seizures in patients with ICH who receive prophylactic levetiracetam.
Methods: This was a retrospective cohort study, conducted at an academic medical center and Comprehensive Stroke Center, that included patients treated for ICH. Patients were excluded if they were younger than 18 years of age, had a documented history of a seizure disorder, or had an AED documented on their home medication list. Patients were dichotomized by their exposure to levetiracetam as seizure prophylaxis. The primary outcome was occurrence of seizure during admission for ICH. Secondary outcomes included occurrence of adverse events, ICU length of stay (LOS), and hospital LOS.
Results: Of the 229 patients included in the final analysis, 21 were in the levetiracetam group (LEV) and 208 were in the no levetiracetam group (no LEV). The majority of the patients were male (61.9% LEV, 54.8% no LEV), white (85.7% LEV, 90.4% no LEV), and presented with a mean ICH score of 3. For the primary outcome of occurrence of seizure during admission, no difference was seen between groups (1 [4.8%] LEV vs. 3 [1.4%] no LEV; p=0.32). There was also no statistical difference in the number of days in the ICU (2 days [1 day, 5 days] LEV vs. 2 days [1 day, 3 days] no LEV; p=0.27), hospital length of stay (6 days [2 days, 8 days] LEV vs. 6 days [3 days, 9 days] no LEV; p=0.27), or adverse events.
Conclusions: Though levetiracetam use following ICH is likely safe, it was not found to reduce the incidence of seizures and should not be routinely recommended as prophylaxis.