Year: 2026 | Month: June | Volume: 16 | Issue: 6 | Pages: 143-151
DOI: https://doi.org/10.52403/ijhsr.20260616
A Comparison of Phenytoin and Levetiracetam for Prophylaxis of Seizures in the Early Postoperative Period in Traumatic Brain Injury Patients
Eman Aftab1, Zulfiqar Ali2, Iqra Nazir3, Adnan Qadri4
1Department of Anesthesiology, SKIMS Medical College, Srinagar, Jammu & Kashmir, India.
2Department of Anesthesiology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, Jammu & Kashmir, India
3Department of Anesthesiology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, Jammu & Kashmir, India
4Department of Anesthesiology, Paras Hospitals, Srinagar, Jammu & Kashmir, India.
Corresponding Author: Dr. Adnan Qadri
ABSTRACT
Background: Early post-traumatic seizures worsen secondary brain injury after severe traumatic brain injury (TBI). Phenytoin remains the traditional prophylactic agent, while levetiracetam has gained popularity because of its favorable safety profile.
Methods: This prospective randomized controlled pilot study was conducted in the Neurosurgical ICU of SKIMS, Srinagar between June 2023 and June 2025. Forty-eight adults with severe TBI (GCS ≤8) were enrolled and randomized to receive phenytoin or levetiracetam. Five patients died during the early study period and were excluded from final analysis, leaving 43 patients (21 phenytoin, 22 levetiracetam). Clinical seizure monitoring and EEG assessments were performed during the first seven days after injury.
Results: Baseline demographics, injury severity, Marshall CT scores, and surgical procedures were comparable between groups. Clinical seizures occurred in 9.5% of phenytoin-treated patients and 4.5% of levetiracetam-treated patients. No significant difference was observed in time to first seizure, EEG epileptiform discharges, ICU stay, neurological recovery, adverse effects, or mortality. Adverse effects were numerically more frequent with phenytoin (19%) than levetiracetam (9%).
Conclusions: Levetiracetam demonstrated efficacy comparable to phenytoin for prevention of early post-traumatic seizures and showed a trend toward improved tolerability. Larger multicenter studies are required to confirm these findings.
Key words: Traumatic brain injury, post-traumatic seizure, prophylaxis of seizures, phenytoin, levetiracetam