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  • Title: [Comparisons of efficacy and safety of levetiracetam versus phenytoin for seizure prophylaxis in patients with brain injury: a meta analysis].
    Author: Li JN, Chen YM.
    Journal: Zhonghua Yi Xue Za Zhi; 2016 Oct 25; 96(39):3170-3177. PubMed ID: 27852418.
    Abstract:
    Objective: To systematically review the efficacy, side effects and case-fatality rate of levetiracetam (LEV) versus phenytoin (PHT) for seizure prophylaxis of brain injured patients. Methods: Randomized controlled trials of high quality about LEV versus PHT in seizure prophylaxis of brain injured patients from 2000 to 2016 were collected according to the key word PHT, LEV, brain injury in PubMed, Medline, Ovid, Springer, CNKI, Wanfang data and so on. Valid data were extracted to conduct meta-analysis by RevMan 5.3 software according to inclusion and exclusion criteria. Results: A total of 13 English articles were finally included with 2 529 patients in total.Meta-analysis showed that no significant differences were observed in LEV versus PHT at preventing the occurrence of seizures (RR=0.88, 95%CI: 0.61-1.27). No superiority of either drug at preventing early seizures (RR=0.74, 95%CI: 0.42-1.27). As to the occurrence of late seizures, the differences of the two drugs were not statistically significant (RR=0.71, 95%CI: 0.43-1.20). Number of patients with side effect was not statistically significantly different between the two groups (RR=0.73, 95%CI: 0.48-1.11). But significant difference was found between LEV and PHT in discontinuation because of side effect (RR=0.11, 95%CI: 0.06-0.23); no significant differences were noted in the case-fatality rate of patients received pretreatment between the two drugs (RR=1.57, 95%CI: 0.92-2.67). There were no significant differences between the two groups in the length of stay (WMD=-1.03, 95%CI: -4.97-2.91). Conclusions: LEV and PHT demonstrate equal efficacy in seizure prevention after brain injury. The differences are insignificant in the side effect, the case-fatality rate and the length of stay between LEV and PH treatment, but adverse drug reactions requiring change in therapy occur more in PHT. Phenytoin remains the first choice for seizure prevention after brain injury based on the existing evidence, while levetiracetam seems to be a favorable choice where there is risk of drug-drug interactions and drug toxicity. However, very few randomized controlled trials on this topic were found, and larger prospective trials are warranted.
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