Phenytoin versus Levetiracetam for Prevention of Early Posttraumatic Seizures: A Prospective Comparative Study

Abstract

Background Antiepileptic drugs are routinely given for the prevention of early posttraumatic seizures (EPTS) occurring within the first 7 days after traumatic brain injury. The objective of this study was to compare phenytoin with levetiracetam in their effectiveness for prophylaxis for EPTS.

Method This single-blinded, prospective randomized study included 100 consecutive admitted patients at our center during a 3-month period from February 1, 2014, to April 30, 2014. Patients with preexisting seizure disorders and pathological brain conditions were excluded from the study. The patients were alternately assigned to a group receiving phenytoin (group P) or a group receiving levetiracetam (group L). Group P patients received phenytoin intravenously at 18 mg/kg as a loading dose followed by a maintenance dose of 5 mg/kg with phenytoin level monitoring. Group L patients received levetiracetam at a dose of 20 mg/kg loading dose and 20 mg/kg/d maintenance dose. A comparative study was done for the occurrence of EPTS and adverse effects in the two groups.

Results One patient in group L (n = 50) and four patients in group P (n = 50) developed EPTS after initiating treatment, but this was not statistically significant (p = 0.362 with odds ratio, OR = 0.24 [95% confidence interval, CI: 0.03–2.17]). There was no statistically significant difference between the two groups in the incidence of drug adverse effects (p = 0.617 with OR = 0.32 [95% CI: 0.03–3.18]). Adverse effects such as poor glycemic control, ataxia, nystagmus, or giddiness were seen in three patients in group P. One patient in group L had sinus bradycardia. Toxic serum drug levels (> 20 µg/mL) were observed in 6 of 50 (12%) patients of group P.

Conclusion There was no significant difference in the occurrence of their adverse effects, but the adverse effects because of the phenytoin were more troublesome. Levetiracetam had a better safety profile than phenytoin and it was equally efficacious for the prevention of EPTS.

Keywords

phenytoin - levetiracetam - early posttraumatic seizures

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