Impact of anti-epileptic drug choice on discharge in acute traumatic brain injury patients

Abstract

Background Anti-epileptic drug (AED) prophylaxis in the first-seven days post-traumatic brain injury (TBI) is known to reduce seizure frequency acutely. AED efficacy is equivalent; therefore, choice of AED may rest with their side-effects. We hypothesise that AEDs that impair balance will prolong recovery, shown by a longer hospital stay. We compared length of hospital stay (and reported dizziness) in TBI patients receiving the commonest AEDs used in our TBI patients, Phenytoin (which may cause imbalance), and Levetiracetam (which does not affect balance). Method A retrospective observational study was performed on TBI patients admitted to a Major Trauma Unit between October 2013 and June 2018. 100 of 278 patients treated with phenytoin or levetiracetam monotherapy for seizure prophylaxis were included. The inclusion criteria of admission Glasgow Coma Score of 14 or more and length of stay less than 3 weeks minimised confounding variables such as non-ambulant patients. Length of hospital stay and incidence of dizziness were assessed. Results The length of hospital stay was longer for patients on Phenytoin versus Levetiracetam, i.e., 10.74 vs. 7.58 days (p = 0.015; unpaired, two-sided t test). Dizziness reported by patients on phenytoin was 24% and levetiracetam was 8% (p = 0.018; Chi-squared test). Conclusion In this cohort, using Phenytoin for acute TBI, seizure prophylaxis was associated with longer length of stay and more dizziness compared to Levetiracetam. Given their equivalent AED efficacy in acute TBI seizure prophylaxis, our data suggest that Levetiracetam is preferable to Phenytoin for early seizure prophylaxis in TBI. This requires evaluation in larger, prospective studies.

Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury

“…Recent studies have demonstrated no evidence that early treatment with ASMs reduces the risk of LPTS or mortality, whereas it seems to adversely affect functional outcome in the long term 14 , 19 , 33 , 41 , 44 – 46 . Levetiracetam, used for early post-TBI seizure prophylaxis, seems to be associated with a shorter length of hospital stay than phenytoin 21 .…”

“…In fact, the recent Brain Trauma Foundation Guidelines 20 recommended the use of prophylactic therapy to decrease the incidence of EPTS within 7 days after severe TBI. Historically, phenytoin has been the ASM of choice as prophylactic therapy, but its complications have led to increasing use of levetiracetam as a substitute 21 . Even on this aspect, there is no clear evidence in the literature 22 .…”

Penggunaan Antikejang Pada Cedera Kepala: Tinjauan Sistematis

“…Seluruh pasien mendapatkan AED berdasarkan kecurigaan klinis berupa kejang maupun memiliki lokasi patologi intrakranial pada CT scan. Adapun dosis rutin yang diberikan adalah fenitoin 300 mg sekali sehari dan levetiracetam 500 mg dua kali sehari kecuali terdapat perbedaan berat badan maupun usia (Harris et al, 2020).…”

“…Pusing lebih sering terjadi pada pasien yang diobati dengan fenitoin dengan presentase 26% dibandingkan pusing yang terjadi pada pasien yang diobati dengan levetiracetam dengan presentase 8%. Diketahui bahwa tidak ditemukan adanya korelasi antara skor total GCSdan durasi lama tinggal pasien di trauma unit (Harris et al, 2020).…”

Деякі Практичні Аспекти Призначення Першої Монотерапії Дорослим Пацієнтам Із Епілепсією

“…Зазначимо, що на сьогодні не застосовують профілактичне лікування епілепсії при будьякій черепномозковій травмі, як це було прийнято ба гато років у нейрохірургів, навіть за відсутності нападів у гострий період травми. Але це не стосується тяжкої черепномозкової травми, оскільки в даний час рекомендується для запобігання раннім нападам застосовувати леветирацетам (кращі результати) або фенітоїн протягом щонайменше 1-2 тиж, якщо користь пере важає ризики [13]. Іноді лікування продовжують до 6 міс.…”