Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Nov;97(48):e13247.
doi: 10.1097/MD.0000000000013247.

Efficacy of levetiracetam compared with phenytoin in prevention of seizures in brain injured patients: A meta-analysis

Lin Zhao  1 , Yu-Peng Wu  1 , Jin-Long Qi  2 , Yong-Qiang Liu  3 , Kai Zhang  4 , Wen-Ling Li  1
Affiliations
Meta-Analysis

Efficacy of levetiracetam compared with phenytoin in prevention of seizures in brain injured patients: A meta-analysis

Lin Zhao et al. Medicine (Baltimore). 2018 Nov.

Abstract

Background: Early and/or late onset in patients with brain injury (BI) is associated with a poorer prognosis, and phenytoin (PHT) is standard of care to prevent seizures. Levetiracetam (LEV), an alternative antiepileptic drug, is associated with less cognitive disruption. The purpose of this study was to evaluate the safety and efficacy of LEV in the prevention of brain traumatic seizures with the standard drug PHT.

Methods: Search the publications on comparison the safety and efficacy of LEV against the standard agent PHT in prevention of traumatic seizures in BI to January 2018. After rigorous reviewing on quality, the data were extracted from eligible trials. All trials analyzed the summary hazard ratios of the endpoints of interest.

Results: LEV was found not more effective than PHT in terms of overall seizure (odds ratio [OR] = 0.73; 95% confidence interval [CI] = 0.51-1.05; P = .09), and late seizure (OR = 0.64; 95% CI = 0.34-1.19; P = .16) occurrence. However, there is significant difference in terms of early seizure (OR = 0.63; 95% CI = 0.40-0.99; P = .04). Moreover, there were no significant differences in terms of mortality (OR = 0.67; 95% CI = 0.43-1.05; P = .08), or side effects (OR = 1.31; 95% CI = 0.80-2.15; P = .29) between groups.

Conclusion: The meta-analysis showed that LEV prevention of seizures was associated with early seizure rates that were lower than the PHT-prolonged course of treatment. There is no statistically significant difference in the efficacy and safety profile of PHT and LEV in cases of traumatic BI.

PubMed Disclaimer

Figures

Figure 1
Figure 1
PRISMA flow chart of selection process to identify studies eligible for pooling.
Figure 2
Figure 2
Pooled analysis of incidence of overall seizures between levetiracetam (LEV) therapy and phenytoin (PHT) therapy.
Figure 3
Figure 3
Pooled analysis of incidence of late seizures between levetiracetam (LEV) therapy and phenytoin (PHT) therapy.
Figure 4
Figure 4
Pooled analysis of incidence of early seizures between levetiracetam (LEV) therapy and phenytoin (PHT) therapy.
Figure 5
Figure 5
Pooled analysis of mortality between levetiracetam (LEV) therapy and phenytoin (PHT) therapy.
Figure 6
Figure 6
Pooled analysis of side-effects between levetiracetam (LEV) therapy and phenytoin (PHT) therapy.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Khan SA, Bhatti SN, Khan AA, et al. Comparison of efficacy of phenytoin and levetiracetam for prevention of early post traumatic seizures. J Ayub Med Coll Abbottabad 2016;28:455–60. - PubMed
    1. Vespa P, Menon D, Le RP. The International Multi-disciplinary Consensus Conference on Multimodality Monitoring: future directions and emerging technologies[J]. Neurocritical Care 2014;21:270–81. - PubMed
    1. Rowe AS, Goodwin H, Brophy GM, et al. Seizure prophylaxis in neurocritical care: a review of evidence-based support. Pharmacotherapy 2014;34:396–409. - PubMed
    1. Bozić K. Prophylactic use of antiepileptic drugs for posttraumatic epilepsy [in Serbian]. Med Pregl 2009;62:501–3. - PubMed
    1. Brain Trauma F. American Association of Neurological S, Congress of Neurological S Guidelines for the management of severe traumatic brain injury. J Neurotrauma 2007;24:S1–06. - PubMed

MeSH terms