Evaluation of Neuropsychiatric Events in Patients Receiving Levetiracetam for Seizure Prophylaxis Following Traumatic Brain Injury

<b>Background:</b> Levetiracetam is a soluble ethyl analogue of the nootropic agent piracetam that is utilized primarily for epilepsy treatment. Studies have shown levetiracetam has preferred pharmacokinetic and pharmacodynamic properties compared to phenytoin, however, limited data exist regarding neuropsychiatric side effects. <b>Purpose:</b> To evaluate the incidence of neuropsychiatric events in patients under the age of 75 and over the age 75 years receiving levetiracetam for seizure prophylaxis following traumatic brain injury (TBI). <b>Methods:</b> This study was a retrospective cohort analysis conducted at the University of Toledo Medical Center (UTMC) between January 1, 2023, and March 15, 2025. Inclusion criteria required adults aged >18 years old who had been admitted to the surgical intensive care unit (SICU) and received levetiracetam for seizure prophylaxis following a TBI. The primary study outcome was to assess the incidence of neuropsychiatric events attributed to levetiracetam. Secondary outcomes included levetiracetam dose/route, seizure occurrence, time to onset of neuropsychiatric event, SICU length of stay and duration of levetiracetam treatment. <b>Results:</b> There were 55 patients included in the study. For the primary endpoint, two patients (3.6%) experienced a neuropsychiatric event. There were 14 patients (25.5%) with a history of psychiatric disorders, and just 1 of those patients experienced a neuropsychiatric event while receiving levetiracetam. <b>Conclusions:</b> Levetiracetam is a well-tolerated antiepileptic agent for patients requiring seizure prophylaxis post TBI and did not demonstrate a significant incidence of neuropsychiatric events in this evaluation.