Department of Pharmacy Services, University of Utah, Salt Lake City, Utah, USA.
School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Brain Inj. 2023 Aug 24;37(10):1167-1172. doi: 10.1080/02699052.2023.2184495. Epub 2023 Mar 1.
BACKGROUND/OBJECTIVE: Levetiracetam is used for seizure prophylaxis in patients presenting with subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI). We aim to characterize the optimal levetiracetam dosage for seizure prophylaxis.
This retrospective cohort study included adult patients at an academic tertiary hospital presenting with SAH or TBI who received levetiracetam at a total daily dose (TDD) equivalent to or greater than 1000 mg. The primary outcome was combined seizure incidence, including clinical and subclinical seizures.
We identified 139 patients (49.6% male, mean age 53 years) for inclusion. For patients receiving a 1000-mg TDD, the administration was 500 mg twice daily. For patients receiving >1000-mg TDD, 77/78 patients received 1000 mg twice daily and one patient received 750 mg twice daily. Patients receiving 1000-mg TDD had a higher seizure incidence than those receiving >1000-mg TDD (p = 0.01), despite no difference in examined confounders, including history of alcoholism (p = 0.49), benzodiazepine use (p = 0.28), or propofol use (p = 0.17). No difference in adverse effects was observed (anemia, p = 0.44; leukopenia, p = 0.60; thrombocytopenia, p = 0.86).
Patients may experience a reduced incidence of clinical and electroencephalographic seizures with levetiracetam dosing >1000-mg TDD.
背景/目的：左乙拉西坦用于预防蛛网膜下腔出血（SAH）或创伤性脑损伤（TBI）患者的癫痫发作。我们旨在确定左乙拉西坦预防癫痫发作的最佳剂量。
本回顾性队列研究纳入了在学术性三级医院就诊的患有 SAH 或 TBI 的成年患者，这些患者接受了等效或大于 1000mg 日总剂量（TDD）的左乙拉西坦治疗。主要结局是包括临床和亚临床发作的复合癫痫发作发生率。
共纳入 139 例患者（49.6%为男性，平均年龄 53 岁）。对于接受 1000mg TDD 的患者，给予 500mg 每日两次。对于接受>1000mg TDD 的患者，77/78 例患者接受 1000mg 每日两次，1 例患者接受 750mg 每日两次。接受 1000mg TDD 的患者癫痫发作发生率高于接受>1000mg TDD 的患者（p=0.01），尽管在检查的混杂因素（包括酒精中毒史[p=0.49]、苯二氮䓬类药物使用[p=0.28]或丙泊酚使用[p=0.17]）方面无差异。未观察到不良反应的差异（贫血，p=0.44；白细胞减少症，p=0.60；血小板减少症，p=0.86）。
与左乙拉西坦 1000mg TDD 相比，较高剂量（>1000mg TDD）可能会降低临床和脑电图癫痫发作的发生率。
