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The Effect of Keppra Prophylaxis on the Incidence of Early Onset, Post-traumatic Brain Injury Seizures
Open accessAbstract
OBJECTIVE: Traumatic brain injury (TBI) is a leading cause of long-term disability. Early onset post-traumatic seizures (PTS) after traumatic injury to the brain is a strong predictor of adverse outcomes in these patients. Our study investigates the role of Keppra in early PTS prophylaxis compared to no treatment, taking into account risk factors including injury severity, seizure history, and anti-epileptic drug (AED) use. METHODS: This was a retrospective cohort study based on patient chart data from January 2013 to January 2017 at a level one trauma center in the United States. A t-test was performed with P<0.05 as significant; we utilized a 95% confidence interval (CI) for our findings. Subgroup analysis was performed, with respect to the Glasgow Coma Scale (GCS) score (Group A: Mild GCS=13-15, Keppra N=135, Non-Keppra N=122; Group B: Moderate GCS=9-12, Keppra N=23, Non-Keppra N=19; Group C: Severe GCS= <8, Keppra N=69, Non-Keppra=35). RESULTS: Of 403 patients included in the study, 227 were given Keppra. Demographics between treatment groups were similar. Whole cohort analysis confirmed six patients with PTS, and no significant difference between groups (Keppra N=3, Non-Keppra N=3, OR=0.77, P=0.75, 95% CI=(0.154-3.87)). Subgroup analysis revealed reduction in seizure incidence in Keppra groups A (OR=0.18, P=0.27, 95% CI=(0.008-3.80)) and B (OR=0.82, P=0.92, 95% CI=(0.015-43.7)), but this reduction was not statistically significant. Those with the severe TBI in group C accounted for the majority of seizures (n=4, OR=1.52, P=0.71, 95% CI=(0.15-15.4)). Conclusion: Patients with more severe TBI suffered a higher incidence of early-onset post-traumatic seizures. Data of the cohort as a whole revealed a trend towards a lower seizure incidence in patients who were treated with Keppra prophylaxis. Despite this trend, the decrease in seizure incidence did not reach statistical significance.
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“Six studies examined specific maternal pregnancy or postpartum outcomes [16,36,47,51,55,56, see Table 4].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [56]
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“For the criterion ‘Were appropriate confounders accounted for in the design and analysis?’, three studies included all vapers without controlling for smoking status and therefore were rated as zero [38, 51, 56] as smoking is likely to be the most important confounder.”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [56]
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“Another study observed increased risk for high maternal blood pressure outcome, but not for gestational diabetes or depression, among those reporting any vaping during the last three months of pregnancy than among non-users [56].”
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“Another study observed significantly higher odds of at least one adverse birth outcome among those reporting any vaping during the last three months of pregnancy than among those who did not, although they did not control for smoking status [56].”
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Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition
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Levetiracetam versus phenytoin for seizure prophylaxis in severe traumatic brain injury
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Use of antiepileptics for seizure prophylaxis after traumatic brain injury
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Low-dose levetiracetam for seizure prophylaxis after traumatic brain injury
Patanwala, A. E., Kurita, A., & Truong, E. (2015) · Brain Injury · doi:10.3109/02699052.2015.1089596 · Cited by 22
Cited by
Golub, V. M., & Reddy, D. S. (2022) · Pharmacological Reviews · doi:10.1124/pharmrev.121.000375 · Cited by 118
Insights into epileptogenesis from post-traumatic epilepsy
Pease, M. W., Gupta, K., Moshé, S. L., Correa, D. J., Galanopoulou, A. S., Okonkwo, D. O., Gonzalez-Martinez, J. A., Shutter, L., Diaz-Arrastia, R. R., & Castellano, J. F. (2024) · Nature Reviews Neurology · doi:10.1038/s41582-024-00954-y · Cited by 72
Early Seizure Prophylaxis in Mild and Moderate Traumatic Brain Injury
Pease, M. W., Mittal, A., Merkaj, S., Okonkwo, D. O., Gonzalez-Martinez, J. A., Elmer, J., Liou, W., Pingue, V., Hammond, F. M., Abramovici, S., et al. (2024) · JAMA Neurology · doi:10.1001/jamaneurol.2024.0689 · Cited by 35
Vaping during pregnancy: a systematic review of health outcomes.
Ussher, M., Fleming, J., & Brose, L. (2024) · BMC pregnancy and childbirth · doi:10.1186/s12884-024-06633-6 · Cited by 27
Huo, X., Xu, X., Li, M., Xiao, L., Wang, Y., Li, W., Wang, C., & Sun, T. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.1001363 · Cited by 22
Metadata
- Authors
- Hazama, A., Ziechmann, R., Arul, M., Krishnamurthy, S., Galgano, M., & Chin, L. S.
- Affiliations
- SUNY Upstate Medical University (US)
- Corresponding author
- Hazama, Ali
- Venue
- Cureus
- Published
- 2018-05-23
- Volume
- 10
- Issue
- 5
- Pages
- e2674-e2674
- ISSN
- 2168-8184 (ISSN-L)
- PMC
- PMC6059528
- OpenAlex
- W2804198774
- Cited by
- 24
- References
- 15
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 1 · 2022: 6 · 2021: 1 · 2020: 3
- FWCI
- 0.68
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Cureus (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Clinical Neurology › Epilepsy research and treatment
- Keywords
- levetiracetam, post-traumatic seizures, traumatic brain injury, seizure prevention, antiepileptic drugs, Glasgow Coma Scale, injury severity, seizure incidence
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