From the Guidelines
Keppra (Levetiracetam) should be dosed at 1,500 mg oral load for post-traumatic seizures, with the option for rapid IV loading safe and well tolerated in doses up to 60 mg/kg, as supported by the most recent evidence 1. The dosing of Keppra for post-traumatic seizures is crucial in preventing further seizure activity and improving patient outcomes. According to the evidence, an oral load of 1,500 mg is recommended, with the option for IV loading in cases where oral administration is not feasible 1.
- The oral loading dose is 1,500 mg, which can be administered as soon as possible after the traumatic brain injury.
- The IV loading dose can be up to 60 mg/kg, which is safe and well tolerated, making it a viable option for patients who cannot take oral medications.
- The evidence suggests that Levetiracetam is effective in preventing seizures, with no seizures reported within 24 hours of loading in a study of oral loading 1.
- The medication is generally well-tolerated, with fatigue, dizziness, and rarely pain at the infusion site being reported as adverse effects 1. The choice of administration route, whether oral or IV, depends on the individual patient's needs and the discretion of the emergency physician, as there is currently a lack of evidence to support one route over the other in terms of preventing early recurrent seizure 1.
From the Research
Levetiracetam Dosing for Post-Traumatic Seizures
- The most commonly reported dosage for Levetiracetam (LEV) is 500 mg twice daily 2.
- A study found that patients receiving a total daily dose (TDD) of 1000 mg had a higher seizure incidence than those receiving >1000-mg TDD, despite no difference in examined confounders 3.
- Another study demonstrated no statistically significant difference in the cumulative incidence of early posttraumatic seizures within 7 days of TBI between three different levetiracetam dosing strategies (≤ 1000 mg/day, 1500 mg/day, and ≥ 2000 mg/day) 4.
- The optimal levetiracetam dosage for seizure prophylaxis is still being characterized, with some studies suggesting that dosing >1000-mg TDD may be associated with a reduced incidence of clinical and electroencephalographic seizures 3.
Comparison with Phenytoin
- Levetiracetam and phenytoin have similar effects on the occurrence of early and late seizures in TBI patients 2, 5, 6.
- Levetiracetam is associated with an increased seizure tendency on EEG analysis compared to phenytoin 5.
- A systematic review found no evidence of a difference in late seizure incidence between levetiracetam and phenytoin, but suggested improved long-term outcomes with levetiracetam 6.