Effectiveness of Fosphenytoin and Levetiracetam to Prevent Posttraumatic Seizures in Young Children with Accidental or Abusive Traumatic Brain Injury

Caitlin R McNamara; Cesar I Menchaca; Taylor J Abel; Christopher M Horvat; Rachel P Berger; Ericka L Fink; Patrick M Kochanek; Dennis W Simon

doi:10.1007/s12028-024-02093-0

Effectiveness of Fosphenytoin and Levetiracetam to Prevent Posttraumatic Seizures in Young Children with Accidental or Abusive Traumatic Brain Injury

Neurocrit Care. 2024 Sep 5. doi: 10.1007/s12028-024-02093-0. Online ahead of print.

Authors

Caitlin R McNamara^{1

2}, Cesar I Menchaca³, Taylor J Abel^{4

5}, Christopher M Horvat^{6

5}, Rachel P Berger^{7

5}, Ericka L Fink^{6

5}, Patrick M Kochanek^{6

5}, Dennis W Simon^{6

5}

Affiliations

¹ Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA. mcnamaracr@upmc.edu.
² UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 2nd Floor, Pittsburgh, PA, 15224-1334, USA. mcnamaracr@upmc.edu.
³ Department of Critical Care Medicine, St. Joseph's Children's Hospital, Tampa, FL, USA.
⁴ Department of Neurological Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
⁵ UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 2nd Floor, Pittsburgh, PA, 15224-1334, USA.
⁶ Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
⁷ Department of Pediatrics and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA.

PMID: 39237847
DOI: 10.1007/s12028-024-02093-0

Abstract

Background: Seizures occur frequently in pediatric patients with traumatic brain injury (TBI), particularly abusive head trauma (AHT). There are limited data on the effectiveness of fosphenytoin and levetiracetam to prevent posttraumatic seizures.

Methods: We performed a retrospective single center cohort study of children < 3 years old admitted with mild [Glasgow Coma Scale (GCS) score 13-15], moderate (GCS 9-12), and severe (GCS 3-8) TBI at a level I trauma center from 2011 to 2021. Antiseizure medications were used at the discretion of the treating physicians. Nonparametric tests were used to compare antiseizure medication prophylaxis and TBI etiology.

Results: A total of 717 patients (263 with AHT, 454 with accidental TBI) were included, of whom 135 (19%) received fosphenytoin, 152 (21%) received levetiracetam, and 430 (60%) did not receive any seizure prophylaxis. Over the study period, the use of fosphenytoin prophylaxis decreased (R² = 0.67, p = 0.004), whereas the use of levetiracetam increased (R² = 0.51, p = 0.008). Additionally, the occurrence of early posttraumatic seizures decreased (R² = 0.58, p = 0.006). Children with AHT were more likely to receive any seizure prophylaxis than those with accidental TBI (52% vs. 27%; p < 0.001) and were more likely to have ≥ 1 seizure during hospitalization (22% vs. 4%; p < 0.001). Among children who received seizure prophylaxis, those who received fosphenytoin had a higher occurrence of seizures than those who received levetiracetam (33% vs.18%; p = 0.004). After controlling for age, admission year, TBI mechanism, and severity of injury, we observed no differences in seizure occurrence between groups.

Conclusions: In children < 3 years old with TBI, no differences were observed in occurrence of seizures between patients who received fosphenytoin and patients who received levetiracetam prophylaxis after controlling for patient factors including severity of injury. Levetiracetam may be an equally effective alternative to fosphenytoin for seizure prophylaxis for early posttraumatic seizure prevention in this age group.

Keywords: Child abuse; Fosphenytoin; Levetiracetam; Prophylaxis; Seizure; Traumatic brain injury.

Abstract

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