LEVETIRACETAM appeared well tolerated for seizure prophylaxis in octogenarians after severe traumatic brain injury, with low discontinuation rates reported.
Levetiracetam for Seizure Prophylaxis After TBI
Levetiracetam is routinely used for seizure prophylaxis after traumatic brain injury, despite limited evidence in patients aged 80 years and older. New retrospective data suggest the drug may be tolerable in this high-risk age group, although the findings also underscore the need for more evidence on long term outcomes.
Traumatic brain injury affects approximately 1.5 million people annually in the U.S., leading to 230,000 hospitalizations and 90,000 long term disabilities. Adults older than 65 years experience the highest rates of hospitalization and death after traumatic brain injury compared with all other age groups.
Early posttraumatic seizures occur within the first 7 days after traumatic brain injury in about 10.8% of patients. Higher Injury Severity Score, Abbreviated Injury Scale score, Glasgow Coma Score, subdural hemorrhage, and subarachnoid hemorrhage have been identified as risk factors.
Severe Injury Shaped Prescribing Patterns
The single center retrospective cohort study included 91 patients aged 80 years and older admitted with severe traumatic brain injury between January 2021 and May 2023. Patients with an active antiepileptic drug prescription were excluded. In total, 59 patients received levetiracetam and 32 did not.
Patients who did not receive levetiracetam were slightly older than those who did, at 87.07 versus 85.91 years. Injury severity differed between groups. Injury Severity Score was higher in the levetiracetam group at 25 versus 17, and maximum Abbreviated Injury Scale Head score was also higher at 5 versus 4.
Three month mortality was significantly higher among patients who received levetiracetam, at 28.8% versus 9.4%. This finding likely reflects that levetiracetam was more often prescribed to patients with more severe traumatic brain injury, rather than demonstrating a direct harmful effect.
Adverse Effects Were Infrequent
Levetiracetam discontinuation due to adverse effects occurred in three patients, representing 5.08% of those treated. Three patients who received levetiracetam experienced seizures within 7 days of traumatic brain injury, but no seizures were reported at 3 month follow up.
Overall, the data suggest levetiracetam may be a well-tolerated option for seizure prophylaxis in octogenarians after severe traumatic brain injury. However, the small sample size, retrospective design, and imbalance in injury severity mean further studies are needed to clarify efficacy, safety, and longer-term outcomes in this vulnerable population.
Reference
Kosuru SB et al. Safety and efficacy of levetiracetam for seizure prophylaxis in octogenarians following traumatic brain injury. Clin Neurol Neurosurg. 2026;268:109471.
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