Journal
ANNALS OF PHARMACOTHERAPY
Volume 48, Issue 11, Pages 1440-1444Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/1060028014549013
Keywords
phenytoin; levetiracetam; traumatic brain injury; seizure; post-traumatic seizure prophylaxis; Glasgow Outcome Scale-Extended; GOS-E; Keppra; fosphenytoin
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Background: Much debate exists on the optimal medication for posttraumatic seizure prophylaxis after traumatic brain injury (TBI). There is some evidence that levetiracetam (LEV) could be neuroprotective and provide long-term benefits in this patient population. Objective: The primary objective was to compare the Glasgow Outcome Scale Extended (GOS-E) 6 months or more after severe TBI. Secondary end points were presence of early seizures (0 to 7 days post-TBI) or late seizures (8 days post-TBI to phone interview), use of anticonvulsant medication when interviewed, medication-related hospital complications, and a summary of phenytoin (PHT) and LEV dosing regimens. Methods: This was an IRB-approved, single-center, prospective cohort analysis. Patients were identified by cross-referencing a list of patients receiving LEV or PHT, with a list of patients with ICD-9 code consistent with TBI. After study inclusion, patients were contacted by telephone, and the GOS-E was administered. Data for secondary end points were gathered by retrospective chart review. Results: In all, 19 patients were included in the final analysis. There was no difference in the GOS-E score assessed >= 6 months after injury (5.07 +/- 1.69 vs 5.60 +/- 2.07, P = 0.58). There was no difference in the secondary end points of early seizures (P = 0.53) or late seizures (P = 0.53). However, the PHT group experienced a higher rate of hospital days with recorded fever (0.20 +/- 0.22 vs 0 0; P = 0.014). Conclusions: Long-term functional outcome in patients who experienced a TBI was not affected by treatment with PHT or LEV; however, patients treated with PHT had a higher incidence of fever during hospitalization.
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