Evaluation of levetiracetam dosing for seizure prophylaxis in traumatic brain injury

Background Early post-traumatic seizures (PTSs) may occur within seven days of traumatic brain injury (TBI). Although levetiracetam is frequently used for early PTS prophylaxis, it is not recommended in current guidelines due to insufficient evidence. The objective of this study was to further evaluate levetiracetam dosing strategies for early PTS prophylaxis. Methods A single-center retrospective cohort study was conducted utilizing the electronic medical record and a trauma database. The primary outcome was an incidence of seizure within seven days of TBI, defined as any documentation of a seizure when utilizing low-dose levetiracetam (500 mg twice daily), compared to high-dose levetiracetam (>500 mg twice daily). Subgroup analyses were performed based on mechanism of injury, trauma type, baseline Glasgow Coma Scale (GCS), injury severity score (ISS), and Augmented Renal Clearance in Trauma Intensive Care score, administration of a loading dose, and additional head injuries. Only patients who completed a full seven-day course of levetiracetam were included. Results Of the 203 patients included, 149 patients received low-dose levetiracetam and 54 patients received high-dose. The majority of patients had a GCS 15 on presentation (92.1%). Twelve of 203 patients (5.9%) experienced a seizure within seven days of TBI, which is similar to the rate seen in previous studies. Six patients in the low-dose group (4.0%) and six patients in the high-dose group (11.1%) experienced a seizure (p = 0.059). There was no statistically significant difference in seizure rate when patients were stratified based on baseline GCS, ISS, or mechanism of injury. Conclusions There were no statistically significant differences in seizure rates when comparing low-dose to high-dose levetiracetam. Levetiracetam 500 mg twice daily may be as effective as levetiracetam doses >500 mg twice daily for early onset post-traumatic seizure prophylaxis.