Abstract:
BACKGROUND:Posttraumatic seizure (PTS) is a significant complication of traumatic brain injury (TBI). OBJECTIVE:To perform a systematic review and meta-analysis to compare levetiracetam with phenytoin for seizure prophylaxis in patients diagnosed with severe TBI. METHODS:An inclusive search of several electronic databases and bibliographies was conducted to identify scientific studies that compared the effect of levetiracetam and phenytoin on PTS. Independent reviewers obtained data and classified the quality of each article that met inclusion criteria. A random effects meta-analysis was then completed. RESULTS:During June and July 2015, a systematic literature search was performed that identified 6097 articles. Of these, 7 met inclusion criteria. A random-effects meta-analysis was performed. A total of 1186 patients were included. The rate of seizure was 35 of 654 (5.4%) in the levetiracetam cohort and 18 of 532 (3.4%) in the phenytoin cohort. Our meta-analysis revealed no change in the rate of early PTS with levetiracetam compared with phenytoin (relative risk, 1.02; 95% confidence interval, 0.53-1.95; P = .96). CONCLUSION:The lack of evidence on which antiepileptic drug to use in PTS is surprising given the number of patients prescribed an antiepileptic drug therapy for TBI. On the basis of currently available Level III evidence, patients treated with either levetiracetam or phenytoin have similar incidences of early seizures after TBI. ABBREVIATIONS:ADE, adverse drug eventAED, antiepileptic drugCI, confidence intervalOR, odds ratioPTS, posttraumatic seizureTBI, traumatic brain injury.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Khan NR,VanLandingham MA,Fierst TM,Hymel C,Hoes K,Evans LT,Mayer R,Barker F,Klimo P Jrdoi
10.1227/NEU.0000000000001445subject
Has Abstractpub_date
2016-12-01 00:00:00pages
775-782issue
6eissn
0148-396Xissn
1524-4040journal_volume
79pub_type
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