Use of levetiracetam in prophylaxis of early post-traumatic seizures

Aim: Traumatic brain injury is one of the leading causes of mortality and morbidity worldwide. The role of prophylactic anti-epileptic drugs has been established. Phenytoin used traditionally for this purpose carries a burden of adverse reactions and cumbersome need of monitoring and maintaining levels in serum. Therefore, as the evidence on levetiracetam, emerged part of neurosurgery section started using this drug for seizure prophylaxis after early loading with phenytoin. So we decided to assess the use of enteral levetiracetam in prophylaxis of early post-traumatic seizures. Material and Methods: This was a retrospective cohort study done at the department of neurosurgery of Aga Khan University in Karachi from July 2010 to March 2011. Charts of patients who were started on levetiracetam enterally were reviewed and followed for occurrence of clinical seizures within one week of trauma. The results were then compared to the group of patients treated prophylactically with phenytoin alone over the same time period. Results: The study included 50 patients in each group. Both groups were comparable in terms of demographics and baseline characteristics. However, 2 patients in each group suffered from clinical seizures with a non-significant p value. ConclusIon: Enteral levetiracetam after initial phenytoin loading is a viable option in the armamentarium of anti-epileptic drugs. Further larger prospective studies are required to improve the evidence.