Incidence of neurobehavioral side effects associated with levetiracetam compared to phenytoin in traumatic brain injury patients

Abstract

Background: Phenytoin is recommended for seizure prophylaxis in traumatic brain injury (TBI). Levetiracetam has been proposed as an alternative agent. The purpose of this study was to determine whether there is a difference in the incidence of neurobehavioral side effects in patients with TBI receiving levetiracetam compared to those receiving phenytoin for seizure prophylaxis.Methods: This was a retrospective cohort study conducted at a level 1 trauma center from June 2008 to April 2014. Patients with TBI aged 16 years and older who received levetiracetam or phenytoin for seizure prophylaxis were evaluated and incidence of neurobehavioral side effects were compared for the two groups.Results: Of the 200 patients who met inclusion criteria, 95 (47.5%) received phenytoin and 105 (52.5%) received levetiracetam. Incidence of neurobehavioral side effects was not statistically different between groups (76 [80%] vs. 75 [71.4%], p = .189). The two groups were well matched.Conclusion: In patients with TBI, receipt of levetiracetam for seizure prophylaxis did not appear to be associated with increased neurobehavioral side effects compared to receipt of phenytoin.

Keywords: Phenytoin; levetiracetam; neurobehavioral effects; seizure prophylaxis; traumatic brain injury.