AIMS AND OBJECTIVES
New research presented at the American Academy of Neurology (AAN) Annual Meeting 20251 reveals critical insights into the comparative efficacy and safety of levetiracetam and phenytoin for seizure prophylaxis in patients with brain injury. Traumatic brain injury is a major cause of disability worldwide, with seizures affecting a significant number of individuals. This umbrella review, synthesizing data from six systematic reviews and meta-analyses, aims to address ongoing uncertainties regarding the effectiveness of these two common anti-epileptic drugs.
METHODS AND RESULTS
A total of 14 randomized controlled trials (RCT) and 43 observational studies were included, with a focus on key outcomes, including seizure prevention, early and late seizure response, mortality, and adverse effects. The findings suggest that while levetiracetam showed a favorable safety profile, with fewer adverse effects (p=0.0003) such as nausea and hypotension, it did not significantly reduce the incidence of seizures (Figure 1) compared to phenytoin. Notably, levetiracetam was associated with a significantly higher mortality rate (p=0.04), which warrants attention in clinical practice.
Figure 1: Forest plot demonstrating the response rate of overall seizures.
Interestingly, both drugs showed similar outcomes in terms of seizure control, length of ICU and hospital stays, and early or late seizure responses. These findings highlight the need for further research to assess the precise role of levetiracetam in managing patients with brain injury, especially given the higher mortality rate observed with its use.
CONCLUSION
The study highlights the importance of ongoing monitoring and research in refining treatment protocols and enhancing patient outcomes. It also points to the critical need for clinicians to carefully evaluate the risk-benefit profile of anti-epileptic drugs in brain injury care, considering both efficacy.
