The safety and efficacy of levetiracetam versus phenytoin for seizure prophylaxis after traumatic brain injury: A systematic review and meta-analysis

Abstract

The meta-analysis suggests that LEV appears to have a similar efficacy to PHT on TBI. A better safety profile of LEV is supported by this analysis.

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

“…Phenytoin carries a high chance of sideeffects, drug interactions, and harmful reactions including cardiotoxicity, anticonvulsant sensitivity syndrome, Stevens-Johnson syndrome, and tissue necrosis [14]. Phenytoin exhibits non-linear pharmacokinetics that necessitates therapeutic drug monitoring, whereas Levetiracetam is easy to dose, and does not require the serum level monitoring [18]. Levetiracetam has a lower rate of intolerable cognitive side-effects (10.4% versus 14.6% for Phenytoin) and gastrointestinal problems [14,18].…”

“…Phenytoin exhibits non-linear pharmacokinetics that necessitates therapeutic drug monitoring, whereas Levetiracetam is easy to dose, and does not require the serum level monitoring [18]. Levetiracetam has a lower rate of intolerable cognitive side-effects (10.4% versus 14.6% for Phenytoin) and gastrointestinal problems [14,18]. Levetiracetam does have a propensity for neuropsychiatric complications with chronic use, although this is of lesser importance for short courses used in acute TBI [15,18].…”

“…Studies, including our own, have shown a favourable safety profile for Levetiracetam over Phenytoin, with fewer complications during hospital admission [14][15][16]. In 2016, Xu et al looked specifically at prophylactic AEDs post-TBI and reported a better safety profile, with a lower adverse drug reaction rate, for Levetiracetam versus Phenytoin [18]. Only eight observational studies and one randomised control study were included in the meta-analysis, with varying sample sizes [18].…”

“…In 2016, Xu et al looked specifically at prophylactic AEDs post-TBI and reported a better safety profile, with a lower adverse drug reaction rate, for Levetiracetam versus Phenytoin [18]. Only eight observational studies and one randomised control study were included in the meta-analysis, with varying sample sizes [18].…”

Current Medical Treatment of Severe Traumatic Brain Injury

“…16 Hayvan deneylerinde nöroprotektif etkileri gösterilen ve son yıllarda kullanımı gittikçe artan levetiresetamın yapılan çalışmalarda antiepileptik etkisinin fenitoin ile benzer, yan etkilerinin fenitoinden daha az olduğu bulunmuştur. [16][17][18][19][20] Yazarlar sundukları olguda 1 posttravmatik epilepsi profilaksisi amacı ile fenitoin kullandıklarını belirtmişlerdir. Yukarıda bahsedilen nedenlerden dolayı epilepsi profilaksisinde levetiresetamın fenitoin ve diğer antiepileptik ilaçlara tercih edilmesi gerektiğini düşünmekteyim.…”