Levetiracetam versus (fos)phenytoin for seizure prophylaxis in pediatric patients with intracranial hemorrhage

Clinical article

View More View Less
  • 1 Departments of Neurology and
  • | 3 Critical Care Medicine, Children's National Medical Center, Washington, DC; and
  • | 2 Department of Psychology, George Mason University, Fairfax, Virginia
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

Seizure prophylaxis is used in a variety of conditions, including supratentorial intracranial hemorrhage (ICH). In adults, studies have demonstrated phenytoin as the drug of choice for seizure prophylaxis; in children, levetiracetam is often provided due to its favorable side effect profile and pharmacokinetics. This study evaluated the difference in efficacy between these treatment options.

Methods

This retrospective review included 126 patients between 1 month and 17 years of age with acute supratentorial ICH; all received seizure prophylaxis. Demographic data and outcome assessments were compared.

Results

Seizure prophylaxis was provided with (fos)phenytoin in 40 children, levetiracetam in 61 children, and both drugs in 25 patients. Baseline characteristics of the treatment groups were similar, except that more patients treated with (fos)phenytoin had seizures on presentation. Patients treated solely with (fos)phenytoin had a higher probability of early seizures (within 7 days of ICH) compared with those treated only with LVT, controlling for relevant variables including seizures on presentation (OR 24.6, p = 0.002). Patients treated with (fos)phenytoin were more likely to need additional antiepileptic drugs for seizure control (p = 0.005). There was no significant difference in the incidence of late seizures (> 7 days after ICH) (p = 0.265). Adverse events necessitating a change in therapy were uncommon.

Conclusions

Levetiracetam is a reasonable alternative to (fos)phenytoin for prophylaxis of early posthemorrhagic seizures. Levetiracetam and (fos)phenytoin are well tolerated in children. Prospective studies are needed to determine superiority, optimal dosing, and impact on long-term outcomes.

Abbreviations used in this paper:

AED = antiepileptic drug; EEG = electroencephalogram; FOS = (fos)phenytoin; ICH = intracranial hemorrhage; ICU = intensive care unit; LVT = levetiracetam; TBI = traumatic brain injury.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Bratton SL, , Chestnut RM, , Ghajar J, , McConnell Hammond FF, , Harris OA, & Hartl R, et al.: Guidelines for the management of severe traumatic brain injury. XIII. Antiseizure prophylaxis. J Neurotrauma 24:Suppl 1 S83S86, 2007. (Erratum in J Neurotrauma 25:276–278, 2008)

    • Search Google Scholar
    • Export Citation
  • 2

    Hahn YS, , Fuchs S, , Flannery AM, , Barthel MJ, & McLone DG: Factors influencing posttraumatic seizures in children. Neurosurgery 22:864867, 1988

    • Search Google Scholar
    • Export Citation
  • 3

    Herman ST: Epilepsy after brain insult: targeting epileptogenesis. Neurology 59:9 Suppl 5 S21S26, 2002

  • 4

    Kochanek PM, , Carney N, & Adelson PD: Guidelines for the early medical management of severe traumatic brain injury in infants, children, and adolescents—second edition. Chapter 17 Antiseizure prophylaxis. Pediatr Crit Care Med 13:1 Suppl S72S82, 2012

    • Search Google Scholar
    • Export Citation
  • 5

    Lewis RJ, , Yee L, , Inkelis SH, & Gilmore D: Clinical predictors of post-traumatic seizures in children with head trauma. Ann Emerg Med 22:11141118, 1993

    • Search Google Scholar
    • Export Citation
  • 6

    Lowenstein DH: Epilepsy after head injury: an overview. Epilepsia 50:Suppl 2 49, 2009

  • 7

    Milligan TA, , Hurwitz S, & Bromfield EB: Efficacy and tolerability of levetiracetam versus phenytoin after supratentorial neurosurgery. Neurology 71:665669, 2008

    • Search Google Scholar
    • Export Citation
  • 8

    Naidech AM, , Kreiter KT, , Janjua N, , Ostapkovich N, , Parra A, & Commichau C, et al.: Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage. Stroke 36:583587, 2005

    • Search Google Scholar
    • Export Citation
  • 9

    Pulman J, , Greenhalgh J, & Marson AG: Antiepileptic drugs as prophylaxis for post-craniotomy seizures. Cochrane Database Syst Rev 2:CD007286, 2013

    • Search Google Scholar
    • Export Citation
  • 10

    Ratan SK, , Kulshreshtha R, & Pandey RM: Predictors of posttraumatic convulsions in head-injured children. Pediatr Neurosurg 30:127131, 1999

    • Search Google Scholar
    • Export Citation
  • 11

    Schreiber JM, , Zelleke T, , Gaillard WD, , Kaulas H, , Dean NP, & Carpenter JL: Continuous video EEG for patients with acute encephalopathy in a pediatric intensive care unit. Neurocrit Care 17:3138, 2012

    • Search Google Scholar
    • Export Citation
  • 12

    Soni S, , Skeens M, , Termuhlen AM, , Bajwa RP, , Gross TG, & Pai V: Levetiracetam for busulfan-induced seizure prophylaxis in children undergoing hematopoietic stem cell transplantation. Pediatr Blood Cancer 59:762764, 2012

    • Search Google Scholar
    • Export Citation
  • 13

    Szaflarski JP, , Sangha KS, , Lindsell CJ, & Shutter LA: Prospective, randomized, single-blinded comparative trial of intravenous levetiracetam versus phenytoin for seizure prophylaxis. Neurocrit Care 12:165172, 2010

    • Search Google Scholar
    • Export Citation
  • 14

    Taylor S, , Heinrichs RJ, , Janzen JM, & Ehtisham A: Levetiracetam is associated with improved cognitive outcome for patients with intracranial hemorrhage. Neurocrit Care 15:8084, 2011

    • Search Google Scholar
    • Export Citation
  • 15

    Temkin NR, , Dikmen SS, , Wilensky AJ, , Keihm J, , Chabal S, & Winn HR: A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med 323:497502, 1990

    • Search Google Scholar
    • Export Citation
  • 16

    Tilford JM, , Simpson PM, , Yeh TS, , Lensing S, , Aitken ME, & Green JW, et al.: Variation in therapy and outcome for pediatric head trauma patients. Crit Care Med 29:10561061, 2001

    • Search Google Scholar
    • Export Citation
  • 17

    Young KD, , Okada PJ, , Sokolove PE, , Palchak MJ, , Panacek EA, & Baren JM, et al.: A randomized, double-blinded, placebo-controlled trial of phenytoin for the prevention of early posttraumatic seizures in children with moderate to severe blunt head injury. Ann Emerg Med 43:435446, 2004

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 566 307 26
Full Text Views 493 35 8
PDF Downloads 525 44 13
EPUB Downloads 0 0 0