Comparison of phenytoin and levetiracetam in preventing early post-traumatic seizures

Background: Anticonvulsant drugs are routinely administered within the first 7 days for the prevention of early post-traumatic seizures (EPTS) after traumatic brain injury. The purpose of this study was to compare the effectiveness and adverse effects of phenytoin and levetiracetam prophylaxis for EPTS. Methods: This single-blinded, prospective, randomized controlled study included 64 patients admitted to our center over 1 year. Patients with previous seizure disorders, those who take anticonvulsant drugs, and those with other brain disorders were excluded from the study. The patients were divided equally into two groups: the phenytoin (PTH) group and the levetiracetam (LEV) group. In the PTH group, patients received an intravenous loading dose of 20 mg/kg, followed by a maintenance dose of 5 mg/kg. In the LEV group, patients received a loading dose of 20 mg/kg and a maintenance dose of 20 mg/kg per day. Results: Two patients in the LEV group (n = 32) and four patients in the PTH group (n = 32) experienced EPTS after initiating treatment, but there was no statistically significant difference between the two groups (p = 0.395). The PTH group experienced a higher incidence of adverse effects such as drug-induced fever and gastrointestinal discomforts (p = 0.017, p = 0.021). Conclusions: There was no significant difference in the occurrence of seizures, but the PTH group experienced more adverse effects, so we recommend levetiracetam to prevent EPTS.