Abstracts

Rationale: Intravenous (IV) levetiracetam (LEV) is an effective antiepileptic drug (AED) with potential to be particularly useful where IV phenytoin (PHY) is contraindicated or not tolerated. We aimed to compare the side effect profile including tolerability of IV LEV and IV PHY and follow-on oral regimens for seizure prophylaxis amongst a neurosurgical patient population. Methods: Study design was single-centre, prospective, block-randomised, and researcher-blinded. Participants received at least one standard dose of IV LEV or IV PHY peri-operatively, then the same oral AED. Side effect profile, medication continuation, and seizure number, were recorded two days post IV administration, at hospital discharge, and three months following surgery, and compared between the AED regimens. Results: 74 participants were randomised. Two-day (two-day to discharge, discharge to 3 month) datasets were complete for 36 (34, 25) LEV and 36 (35, 18) PHY participants. 81% (82%, 56%) LEV vs. 86% (89%, 72%) PHY recorded no systemic side effects [p=0.38 (0.35, 0.22)]; 3% (3%, 4%) LEV vs. 6% (3%, 17%) PHY recorded major systemic side effects [p=0.50 (p=0.51, 0.19)]; line-site complication was recorded only in the PHY group (6% [p=0.25]); 0% (0%, 4%) LEV vs. 3% (3%, 28%) PHY ceased medication because of AED side effects [p=0.50 (0.51, 0.04)]; seizures occurred in 3% (3%, 0%) of patients taking PHY, and none taking LEV [p=0.50 (0.51, 1.0)]. Conclusions: IV LEV and IV PHY are well tolerated peri-operatively. Oral LEV was better tolerated at 3 months. Lower than expected local side effect frequency for IV PHY may reflect anaesthetist technique.