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Prevalence of Early Posttraumatic Seizures in Children With Moderate to Severe Traumatic Brain Injury Despite Levetiracetam Prophylaxis*

Chung, Melissa G. MD; O’Brien, Nicole F. MD

Pediatric Critical Care Medicine: February 2016 - Volume 17 - Issue 2 - p 150–156
doi: 10.1097/PCC.0000000000000588
Neurocritical Care

Objectives: To evaluate the prevalence of early seizures after levetiracetam prophylaxis in children with moderate to severe traumatic brain injury.

Design: Prospective observational study.

Setting: Level 1 pediatric trauma center.

Patients: We enrolled 34 patients between the ages of 0–18 years with moderate to severe traumatic brain injury admitted to the PICU at a level 1 trauma center who received levetiracetam for early posttraumatic seizure prophylaxis.

Measurements and Main Results: Primary outcome was the prevalence of early posttraumatic seizures that were defined as clinical seizures within 7 days of injury. In 6 of 34 patients (17%), clinical seizures developed despite levetiracetam prophylaxis. An additional two patients had nonconvulsive seizures. This prevalence is similar to that reported in the literature in this patient population who do not receive seizure prophylaxis (20–53%) and is higher than that in patients who receive phenytoin prophylaxis (2–15%). Patients with early posttraumatic seizures were younger (median age, 4 mo) (p < 0.001) and more likely to have suffered from abusive head trauma (p < 0.0004).

Conclusions: Early clinical posttraumatic seizures occurred frequently in children with moderate to severe traumatic brain injury despite seizure prophylaxis with levetiracetam. Younger children and those with abusive head trauma were at increased risk of seizures. Further studies are needed to evaluate the efficacy of levetiracetam before it is routinely used for seizure prophylaxis in these children, particularly in young children and those who have suffered from abusive head trauma.

1Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, the Ohio State University, Columbus, OH.

2Section of Neurology, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH.

*See also p. 173.

The authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Melissa G. Chung, MD, Section of Neurology, 700 Children’s Dr., Columbus, OH 43205.

©2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies