Initial EEG predicts outcomes in a trial of levetiracetam vs. fosphenytoin for
seizure prevention.
Author(s): Steinbaugh LA, Lindsell CJ, Shutter LA, Szaflarski JP.
Affiliation(s): Department of Neurology, University of Cincinnati Academic Health Center,
Cincinnati, OH 45267-0525, USA.
Publication date & source: 2012, Epilepsy Behav. , 23(3):280-4
Continuous electroencephalography (cEEG) is increasingly used to detect both
clinical and subclinical seizures in patients with traumatic brain injury (TBI)
or subarachnoid hemorrhage (SAH). We assess whether EEG findings predict outcomes
in TBI/SAH patients enrolled in a levetiracetam (LEV) vs. fosphenytoin (fos-PHT)
seizure prevention trial (NCT00618436). This prospective, single-blinded,
comparative trial randomized 52 patients with TBI or SAH to receive prophylactic
LEV or fos-PHT. Continuous video EEG monitoring was conducted for the initial 72
h of medication administration. The association between EEG findings (degree of
generalized and focal slowing, presence and frequency of epileptiform discharges
and seizures) and outcomes (Glasgow Outcomes Scale-Extended (GOS-E) and
Disability Rating Scale (DRS)) at discharge, 3 and 6 months was assessed using a
generalized linear model. Severity of generalized slowing tended to be associated
with outcomes in both treatment groups (discharge DRS, p=0.042; discharge GOS-E,
p=0.026; 3 month DRS, p=0.051). The presence of focal slowing, the presence and
frequency of epileptiform discharges and the presence of seizures were not
predictive of outcome in either treatment group (all p>0.15). While it has been
shown that LEV is associated with better outcome than fos-PHT when used as
seizure prophylaxis in brain injury, aside from severity of generalized slowing,
electrographic findings of focal slowing, epileptiform discharges, and seizures
were not themselves associated with outcomes in patients with TBI or SAH enrolled
in a randomized clinical trial.
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