From the Guidelines
Levetiracetam (Keppra) prophylaxis is not recommended for primary prevention of post-traumatic seizures in traumatic brain injury (TBI) patients, except in cases with specific risk factors such as chronic subdural hematoma or past history of epilepsy. The evidence from recent studies, including a 2018 review in the journal Anaesthesia 1, suggests that antiepileptic drugs, including levetiracetam, do not significantly reduce the incidence of early or delayed post-traumatic seizures.
Key points to consider:
- The incidence of early clinical seizures within 7 days after brain injury is relatively low, at 2.2%, and the incidence of delayed seizures after 7 days is 2.1% 1.
- Risk factors for delayed clinical seizures include brain contusion, acute subdural hematoma, skull fracture, initial loss of consciousness or amnesia for more than 24 hours, and age over 65 years 1.
- Eleven clinical trials studying primary prevention of post-traumatic seizures found no significant effect of antiepileptic drugs in preventing early or delayed seizures, apart from an older meta-analysis that favored phenytoin for early seizure prevention 1.
- Levetiracetam may be considered in patients with specific risk factors due to its higher degree of tolerance compared to phenytoin 1.
In clinical practice, the decision to use levetiracetam prophylaxis should be based on individual patient risk assessment, considering the potential benefits and risks, including side effects and the lack of clear evidence for preventing late seizures or improving long-term outcomes.
From the Research
Indications for Levetiracetam (Keppra) Prophylaxis in Traumatic Brain Injury (TBI)
- The use of Levetiracetam (Keppra) for prophylaxis in Traumatic Brain Injury (TBI) is mentioned in the context of early seizure prophylaxis 2.
- Early seizure prophylaxis is considered an important aspect of optimizing the acute care of severe TBI, along with recognition and treatment of paroxysmal sympathetic hyperactivity (PSH), venous thromboembolism (VTE) prophylaxis, and nutrition optimization 2.
- However, the specific indications for Levetiracetam (Keppra) prophylaxis in TBI are not explicitly stated in the provided studies.
- Studies focus on the epidemiology, outcome, and dating of extra-axial hematomas, such as subdural and epidural hematomas, which are common clinical entities after a traumatic brain injury (TBI) 3, 4, 5, 6.
- The management of severe TBI should focus on avoiding secondary brain injury from hypotension and hypoxia, with appropriate reversal of anticoagulation and surgical evacuation of mass lesions as indicated 2.
Related Factors
- The presence of subdural hematoma (SDH) is associated with worse outcomes in TBI patients, including lower likelihood of discharge to home and higher perihospital mortality rates 3.
- The epidemiology of surgically treated acute subdural and epidural hematomas in patients with head injuries shows that these conditions are relatively rare and generally associated with good outcomes 4.
- The occurrence of subdural and epidural hematomas is related to the head impact site, with a higher proportion of subdural hematomas found in cases where the site of impact was the temporal region 6.