Efficacy of levetiracetam compared with phenytoin in prevention of seizures in brain injured patients A meta-analysis

Background: Early and/or late onset in patients with brain injury (BI) is associated with a poorer prognosis, and phenytoin (PHT) is standard of care to prevent seizures. Levetiracetam (LEV), an alternative antiepileptic drug, is associated with less cognitive disruption. The purpose of this study was to evaluate the safety and efficacy of LEV in the prevention of brain traumatic seizures with the standard drug PHT. Methods: Search the publications on comparison the safety and efficacy of LEV against the standard agent PHT in prevention of traumatic seizures in BI to January 2018. After rigorous reviewing on quality, the data were extracted from eligible trials. All trials analyzed the summary hazard ratios of the endpoints of interest. Results: LEV was found not more effective than PHT in terms of overall seizure (odds ratio [OR]=0.73; 95% confidence interval [CI]=0.51-1.05; P=.09), and late seizure (OR=0.64; 95% CI=0.34-1.19; P=.16) occurrence. However, there is significant difference in terms of early seizure (OR=0.63; 95% CI=0.40-0.99; P=.04). Moreover, there were no significant differences in terms of mortality (OR=0.67; 95% CI=0.43-1.05; P=.08), or side effects (OR=1.31; 95% CI=0.80-2.15; P=.29) between groups. Conclusion: The meta-analysis showed that LEV prevention of seizures was associated with early seizure rates that were lower than the PHT-prolonged course of treatment. There is no statistically significant difference in the efficacy and safety profile of PHT and LEV in cases of traumatic BI.