Should Levetiracetam or Phenytoin Be Used for Posttraumatic Seizure Prophylaxis? A Systematic Review of the Literature and Meta-analysis

被引:26
|
作者
Khan, Nickalus R. [1 ]
VanLandingham, Matthew A. [1 ]
Fierst, Tamara M. [2 ]
Hymel, Caroline [3 ]
Hoes, Kathryn [4 ]
Evans, Linton T. [5 ]
Mayer, Rory [6 ]
Barker, Fred [7 ]
Klimo, Paul, Jr. [1 ,8 ]
机构
[1] Univ Tennessee, Ctr Hlth Sci, Dept Neurosurg, Memphis, TN 38163 USA
[2] Temple Univ, Sch Med, Dept Neurosurg, Philadelphia, PA 19122 USA
[3] Univ Memphis, Dept Psychol & Neurosci, Memphis, TN 38152 USA
[4] Univ Texas Southwestern, Dept Neurosurg, Dallas, TX USA
[5] Dartmouth Hitchcock Hosp, Dept Neurosurg, Lebanon, NH USA
[6] Baylor Coll Med, Dept Neurosurg, Houston, TX 77030 USA
[7] Massachusetts Gen Hosp, Dept Neurosurg, Boston, MA 02114 USA
[8] Semmes Murphey Neurol & Spine Inst, 6325 Humphreys Blvd, Memphis, TN 38120 USA
关键词
Dilantin; Keppra; Levetiracetam; Meta-analysis; Phenytoin; Seizures; Trauma; INTRAVENOUS LEVETIRACETAM; BRAIN-INJURY; PREVENTION; EPILEPSY; QUALITY; BIAS;
D O I
10.1227/NEU.0000000000001445
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Posttraumatic seizure (PTS) is a significant complication of traumatic brain injury (TBI). OBJECTIVE: To perform a systematic review and meta-analysis to compare levetiracetam with phenytoin for seizure prophylaxis in patients diagnosed with severe TBI. METHODS: An inclusive search of several electronic databases and bibliographies was conducted to identify scientific studies that compared the effect of levetiracetam and phenytoin on PTS. Independent reviewers obtained data and classified the quality of each article that met inclusion criteria. A random effects meta-analysis was then completed. RESULTS: During June and July 2015, a systematic literature search was performed that identified 6097 articles. Of these, 7 met inclusion criteria. A random-effects meta-analysis was performed. A total of 1186 patients were included. The rate of seizure was 35 of 654 (5.4%) in the levetiracetam cohort and 18 of 532 (3.4%) in the phenytoin cohort. Our meta-analysis revealed no change in the rate of early PTS with levetiracetam compared with phenytoin (relative risk, 1.02; 95% confidence interval, 0.53-1.95; P = .96). CONCLUSION: The lack of evidence on which antiepileptic drug to use in PTS is surprising given the number of patients prescribed an antiepileptic drug therapy for TBI. On the basis of currently available Level III evidence, patients treated with either levetiracetam or phenytoin have similar incidences of early seizures after TBI.
引用
收藏
页码:775 / 781
页数:7
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