Prospective, Randomized, Single-Blinded Comparative Trial of Intravenous Levetiracetam Versus Phenytoin for Seizure Prophylaxis

Szaflarski, Jerzy P.; Sangha, Kiranpal S.; Lindsell, Christopher J.; Shutter, Lori

doi:10.1007/s12028-009-9304-y

Cited by 268 publications

(222 citation statements)

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“…Statistically, no significant difference was found between the two drugs in terms of seizure control but the incidence of abnormal EEG was higher in the levetiracetam group in their study (9). A randomized controlled trial by Szaflarski et al compared the two drugs in patients with subarachnoid hemorrhage and traumatic brain injury (17). This study also showed better long-term outcomes in patients that received levetiracetam.…”

Section: █ Discussionmentioning

confidence: 89%

“…It does not induce fever, cutaneous hypersensitivity reactions or have drug interactions (13). Recently, the effectiveness of levetiracetam has been studied in the prophylaxis of post-traumatic seizures (9) and seizures following trauma and subarachnoid hemorrhage (17). Jones et al (9) have compared the drugs in severe traumatic brain injury and did not find a statistically significant difference between the two drugs.…”

Section: █ Introductionmentioning

confidence: 99%

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Use of enteral levetiracetam for prophylaxis of early post traumatic seizures

Javed¹,

Waqas²,

Qadeer³

et al. 2014

Turkish Neurosurgery

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Section: █ Discussionmentioning

confidence: 89%

Section: █ Introductionmentioning

confidence: 99%

Use of enteral levetiracetam for prophylaxis of early post traumatic seizures

Javed¹,

Waqas²,

Qadeer³

et al. 2014

Turkish Neurosurgery

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“…This study is inconclusive as to the effect of levetiracetam. Moreover, a benefit on seizure occurrence after TBI was not observed in a small randomized, single-blinded, comparative trial of levetiracetam versus phenytoin in patients with severe TBI [65].…”

Section: Levetiracetammentioning

confidence: 96%

The Potential of Antiseizure Drugs and Agents that Act on Novel Molecular Targets as Antiepileptogenic Treatments

2014

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A major goal of contemporary epilepsy research is the identification of therapies to prevent the development of recurrent seizures in individuals at risk, including those with brain injuries, infections, or neoplasms; status epilepticus; cortical dysplasias; or genetic epilepsy susceptibility. In this review we consider the evidence largely from preclinical models for the antiepileptogenic activity of a diverse range of potential therapies, including some marketed antiseizure drugs, as well as agents that act by immune and inflammatory mechanisms; reduction of oxidative stress; activation of the mammalian target of rapamycin or peroxisome proliferatoractivated receptors γ pathways; effects on factors related to thrombolysis, hematopoesis, and angiogenesis; inhibition of 3-hydroxy-3-methylglutaryl-coenzyme A reducatase; brainderived neurotrophic factor signaling; and blockade of α2 adrenergic and cannabinoid receptors. Antiepileptogenesis refers to a therapy of which the beneficial action is to reduce seizure frequency or severity outlasting the treatment period. To date, clinical trials have failed to demonstrate that antiseizure drugs have such disease-modifying activity. However, studies in animal models with levetiracetam and ethosuximide are encouraging, and clinical trials with these agents are warranted. Other promising strategies are inhibition of interleukin 1β signaling by drugs such as VX-765; modulation of sphingosine 1-phosphate signaling by drugs such as fingolimod; activation of the mammalian target of rapamycin by drugs such as rapamycin; the hormone erythropoietin; and, paradoxically, drugs such as the α2 adrenergic receptor antagonist atipamezole and the CB1 cannabinoid antagonist SR141716A (rimonabant) with proexcitatory activity. These approaches could lead to a new paradigm in epilepsy drug therapy where treatment for a limited period prevents the occurrence of spontaneous seizures, thus avoiding lifelong commitment to symptomatic treatment.

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“…Shorter duration prophylaxis has been advocated and a 3-7 day course of prophylaxis is general practice. Other anti-epileptic agents have been investigated and levetiracetam has been shown to be equally efficacious in reducing early seizures as well as improved functional recovery in comparison to those patients treated with phenytoin [47]. The current recommendation is to consider using short-term (3-7 days) of agents other than phenytoin, such as levetiracetam, for seizure prophylaxis.…”

Section: Seizurementioning

confidence: 99%