Evaluation of levetiracetam for early post-traumatic seizure prophylaxis: A level II trauma center experience
Traumatic brain injury (TBI) can induce early or late post-traumatic seizures (PTS). While PTS incidence is low, prophylaxis is used despite a lack of consensus on agent or duration. Levetiracetam (LEV) for early PTS prophylaxis is preferred due to its safety and efficacy. The purpose of this study...
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| Veröffentlicht in: | The surgeon (Edinburgh) 2023-04, Vol.21 (2), p.e78-e82 |
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| creator | Amin, Timothy A. Nerenberg, Steven F. Elsawy, Osama A. Wang, Antai Johnston, Jackie P. |
| description | Traumatic brain injury (TBI) can induce early or late post-traumatic seizures (PTS). While PTS incidence is low, prophylaxis is used despite a lack of consensus on agent or duration. Levetiracetam (LEV) for early PTS prophylaxis is preferred due to its safety and efficacy. The purpose of this study was to evaluate LEV for early PTS prophylaxis.
A single-center, retrospective chart review of TBI patients ≥18 years who received LEV for early PTS prophylaxis between August 2018–July 2019. The primary outcome was LEV duration. Secondary outcomes were incidence of seizure, intensive care unit (ICU) and hospital length of stay (LOS).
Of the 137 included, mean age was 59 ± 20 years and 69.3% were male. The mean admission GCS was 13 ± 4 and 77.4% had mild TBI. Median LEV duration was 7 (IQR 4–10) days and 13.9% met recommended 7-day duration. Those prescribed LEV >7 days had more than twice the median LEV duration than those prescribed ≤7 days [10.25 (8.5–15.5) vs 4 (1.5–4.5) days, p |
| doi_str_mv | 10.1016/j.surge.2022.05.001 |
| format | Article |
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A single-center, retrospective chart review of TBI patients ≥18 years who received LEV for early PTS prophylaxis between August 2018–July 2019. The primary outcome was LEV duration. Secondary outcomes were incidence of seizure, intensive care unit (ICU) and hospital length of stay (LOS).
Of the 137 included, mean age was 59 ± 20 years and 69.3% were male. The mean admission GCS was 13 ± 4 and 77.4% had mild TBI. Median LEV duration was 7 (IQR 4–10) days and 13.9% met recommended 7-day duration. Those prescribed LEV >7 days had more than twice the median LEV duration than those prescribed ≤7 days [10.25 (8.5–15.5) vs 4 (1.5–4.5) days, p < 0.0001]. Electroencephalography-confirmed PTS occurred in 2.2%, with an early PTS incidence of 0.73%. Median ICU and hospital LOS were 2 (IQR 1–7) and 7 (IQR 3–16) days, respectively.
The incidence of PTS was low as most patients in our study had mild or moderate TBI. Early PTS prophylaxis with LEV for 7 days is appropriate, although the majority of patients did not meet the recommended duration. Efforts to standardize and implement PTS prophylaxis protocols are needed.
•Traumatic brain injury (TBI) can induce early post-traumatic seizures (PTS).•Early PTS prophylaxis with anti-epileptics should be reserved severe TBI patients.•A total antiepileptic duration of 7 days is appropriate for most TBI patients.•Levetiracetam is preferred for its safety and efficacy in preventing early PTS.</description><identifier>ISSN: 1479-666X</identifier><identifier>EISSN: 2405-5840</identifier><identifier>DOI: 10.1016/j.surge.2022.05.001</identifier><identifier>PMID: 35660071</identifier><language>eng</language><publisher>Scotland: Elsevier Ltd</publisher><subject>Adult ; Aged ; Anticonvulsants - therapeutic use ; Antiepileptic ; Epilepsy, Post-Traumatic - drug therapy ; Female ; Humans ; Levetiracetam - therapeutic use ; Male ; Middle Aged ; Piracetam - therapeutic use ; Retrospective Studies ; Seizure ; Trauma ; Trauma Centers ; Traumatic brain injury</subject><ispartof>The surgeon (Edinburgh), 2023-04, Vol.21 (2), p.e78-e82</ispartof><rights>2022 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland</rights><rights>Copyright © 2022 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c404t-9d4284da2d412db13e7ca8afb7737270ee082b5e821a09634d241080b8e1b2f23</citedby><cites>FETCH-LOGICAL-c404t-9d4284da2d412db13e7ca8afb7737270ee082b5e821a09634d241080b8e1b2f23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.surge.2022.05.001$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27926,27927,45997</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35660071$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Amin, Timothy A.</creatorcontrib><creatorcontrib>Nerenberg, Steven F.</creatorcontrib><creatorcontrib>Elsawy, Osama A.</creatorcontrib><creatorcontrib>Wang, Antai</creatorcontrib><creatorcontrib>Johnston, Jackie P.</creatorcontrib><title>Evaluation of levetiracetam for early post-traumatic seizure prophylaxis: A level II trauma center experience</title><title>The surgeon (Edinburgh)</title><addtitle>Surgeon</addtitle><description>Traumatic brain injury (TBI) can induce early or late post-traumatic seizures (PTS). While PTS incidence is low, prophylaxis is used despite a lack of consensus on agent or duration. Levetiracetam (LEV) for early PTS prophylaxis is preferred due to its safety and efficacy. The purpose of this study was to evaluate LEV for early PTS prophylaxis.
A single-center, retrospective chart review of TBI patients ≥18 years who received LEV for early PTS prophylaxis between August 2018–July 2019. The primary outcome was LEV duration. Secondary outcomes were incidence of seizure, intensive care unit (ICU) and hospital length of stay (LOS).
Of the 137 included, mean age was 59 ± 20 years and 69.3% were male. The mean admission GCS was 13 ± 4 and 77.4% had mild TBI. Median LEV duration was 7 (IQR 4–10) days and 13.9% met recommended 7-day duration. Those prescribed LEV >7 days had more than twice the median LEV duration than those prescribed ≤7 days [10.25 (8.5–15.5) vs 4 (1.5–4.5) days, p < 0.0001]. Electroencephalography-confirmed PTS occurred in 2.2%, with an early PTS incidence of 0.73%. Median ICU and hospital LOS were 2 (IQR 1–7) and 7 (IQR 3–16) days, respectively.
The incidence of PTS was low as most patients in our study had mild or moderate TBI. Early PTS prophylaxis with LEV for 7 days is appropriate, although the majority of patients did not meet the recommended duration. Efforts to standardize and implement PTS prophylaxis protocols are needed.
•Traumatic brain injury (TBI) can induce early post-traumatic seizures (PTS).•Early PTS prophylaxis with anti-epileptics should be reserved severe TBI patients.•A total antiepileptic duration of 7 days is appropriate for most TBI patients.•Levetiracetam is preferred for its safety and efficacy in preventing early PTS.</description><subject>Adult</subject><subject>Aged</subject><subject>Anticonvulsants - therapeutic use</subject><subject>Antiepileptic</subject><subject>Epilepsy, Post-Traumatic - drug therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Levetiracetam - therapeutic use</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Piracetam - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Seizure</subject><subject>Trauma</subject><subject>Trauma Centers</subject><subject>Traumatic brain injury</subject><issn>1479-666X</issn><issn>2405-5840</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1PGzEQhq2qqKTAL6hU-djLLuOv_ajUQxRBiRSJC0jcLK93FhztV21vRPj1LAnlyGkuz_vOzEPIDwYpA5ZdbtMw-UdMOXCegkoB2Bey4BJUogoJX8mCybxMsix7OCXfQ9gCcCVAfSOnQmUZQM4WpLvamXYy0Q09HRra4g6j88ZiNB1tBk_R-HZPxyHEJHozdTNqaUD3Mnmkox_Gp31rnl34TZeHdEvXa3okqcU-4lzxPKJ32Fs8JyeNaQNevM8zcn99dbe6STa3f9er5SaxEmRMylryQtaG15LxumICc2sK01R5LnKeAyIUvFJYcGagzISsuWRQQFUgq3jDxRn5deydD_w3YYi6c8Fi25oehylonuVClaosxIyKI2r9EILHRo_edcbvNQP95llv9cGzfvOsQenZ85z6-b5gqjqsPzL_xc7AnyOA85s7h14He1BQO4826npwny54BXymkRc</recordid><startdate>202304</startdate><enddate>202304</enddate><creator>Amin, Timothy A.</creator><creator>Nerenberg, Steven F.</creator><creator>Elsawy, Osama A.</creator><creator>Wang, Antai</creator><creator>Johnston, Jackie P.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202304</creationdate><title>Evaluation of levetiracetam for early post-traumatic seizure prophylaxis: A level II trauma center experience</title><author>Amin, Timothy A. ; Nerenberg, Steven F. ; Elsawy, Osama A. ; Wang, Antai ; Johnston, Jackie P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c404t-9d4284da2d412db13e7ca8afb7737270ee082b5e821a09634d241080b8e1b2f23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anticonvulsants - therapeutic use</topic><topic>Antiepileptic</topic><topic>Epilepsy, Post-Traumatic - drug therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Levetiracetam - therapeutic use</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Piracetam - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Seizure</topic><topic>Trauma</topic><topic>Trauma Centers</topic><topic>Traumatic brain injury</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Amin, Timothy A.</creatorcontrib><creatorcontrib>Nerenberg, Steven F.</creatorcontrib><creatorcontrib>Elsawy, Osama A.</creatorcontrib><creatorcontrib>Wang, Antai</creatorcontrib><creatorcontrib>Johnston, Jackie P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The surgeon (Edinburgh)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Amin, Timothy A.</au><au>Nerenberg, Steven F.</au><au>Elsawy, Osama A.</au><au>Wang, Antai</au><au>Johnston, Jackie P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of levetiracetam for early post-traumatic seizure prophylaxis: A level II trauma center experience</atitle><jtitle>The surgeon (Edinburgh)</jtitle><addtitle>Surgeon</addtitle><date>2023-04</date><risdate>2023</risdate><volume>21</volume><issue>2</issue><spage>e78</spage><epage>e82</epage><pages>e78-e82</pages><issn>1479-666X</issn><eissn>2405-5840</eissn><abstract>Traumatic brain injury (TBI) can induce early or late post-traumatic seizures (PTS). While PTS incidence is low, prophylaxis is used despite a lack of consensus on agent or duration. Levetiracetam (LEV) for early PTS prophylaxis is preferred due to its safety and efficacy. The purpose of this study was to evaluate LEV for early PTS prophylaxis.
A single-center, retrospective chart review of TBI patients ≥18 years who received LEV for early PTS prophylaxis between August 2018–July 2019. The primary outcome was LEV duration. Secondary outcomes were incidence of seizure, intensive care unit (ICU) and hospital length of stay (LOS).
Of the 137 included, mean age was 59 ± 20 years and 69.3% were male. The mean admission GCS was 13 ± 4 and 77.4% had mild TBI. Median LEV duration was 7 (IQR 4–10) days and 13.9% met recommended 7-day duration. Those prescribed LEV >7 days had more than twice the median LEV duration than those prescribed ≤7 days [10.25 (8.5–15.5) vs 4 (1.5–4.5) days, p < 0.0001]. Electroencephalography-confirmed PTS occurred in 2.2%, with an early PTS incidence of 0.73%. Median ICU and hospital LOS were 2 (IQR 1–7) and 7 (IQR 3–16) days, respectively.
The incidence of PTS was low as most patients in our study had mild or moderate TBI. Early PTS prophylaxis with LEV for 7 days is appropriate, although the majority of patients did not meet the recommended duration. Efforts to standardize and implement PTS prophylaxis protocols are needed.
•Traumatic brain injury (TBI) can induce early post-traumatic seizures (PTS).•Early PTS prophylaxis with anti-epileptics should be reserved severe TBI patients.•A total antiepileptic duration of 7 days is appropriate for most TBI patients.•Levetiracetam is preferred for its safety and efficacy in preventing early PTS.</abstract><cop>Scotland</cop><pub>Elsevier Ltd</pub><pmid>35660071</pmid><doi>10.1016/j.surge.2022.05.001</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Anticonvulsants - therapeutic use Antiepileptic Epilepsy, Post-Traumatic - drug therapy Female Humans Levetiracetam - therapeutic use Male Middle Aged Piracetam - therapeutic use Retrospective Studies Seizure Trauma Trauma Centers Traumatic brain injury |
| title | Evaluation of levetiracetam for early post-traumatic seizure prophylaxis: A level II trauma center experience |
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