Recommended Citation
Alwan A, McInerney A, Piech L. Comparison of Dosing Strategies of Levetiracetam for Seizure Prophylaxis in Patients with Traumatic Brain Injury. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Traumatic brain injury (TBI) affects around 1.7 million individuals annually in the United States and is associated with detrimental complications including seizures. Anticonvulsants are used prophylactically, with the 2024 Neurocritical Care Society Clinical Practice Guideline recommending levetiracetam as the preferred agent. However, no standardized dosing strategies currently exist, resulting in variability in both loading and maintenance of dose regimens across institutions and among providers. The aim of this project is to identify the most appropriate dosing strategy of levetiracetam to reduce seizure incidence in patients with TBI.
Purpose:
This project aimed to identify the most appropriate dosing strategy of levetiracetam to reduce seizure incidence in patients with TBI.
Methods:
This retrospective chart review compared different dosing strategies of levetiracetam for seizure prophylaxis at two institutions. It included patients admitted from 11/1/2020 through 8/1/2025 with a diagnosis of TBI who received levetiracetam during the initial 7 days following the injury. Those with history of seizures, prehospital use of anticonvulsants, seizure onset prior to medication administration, aneurysmal subarachnoid hemorrhage, or catastrophic brain injury with death within 48 hours were excluded from the study. The primary outcome was the incidence of seizures following TBI. Secondary outcomes included hospital and intensive care unit length of stay, need for rescue therapy due to seizures, and discontinuation rates due to adverse drug reactions. Data collected included the mechanism of injury, severity of brain injury, seizure type and method of diagnosis, dose of levetiracetam, duration of therapy, use of additional antiseizure drugs, adverse drug reactions, and disposition at discharge. This study was approved by the Institutional Review Board.
Results:
Out of the 3,718 patients screened, 825 met the inclusion criteria. Patients were divided into three groups based on loading doses: >20 mg/kg (n=276), <20 mg/kg (n=209), or no loading dose (n=152). The incidence of seizures was 39 (14.1%), 54 (25.8%), and 19 (12.5%) respectively in these groups (p=0.001), with a higher incidence of early onset seizures in all groups. A subgroup analysis of maintenance dosing was performed and found that doses of 500 mg every 12 hours were associated with a higher incidence of seizure compared to higher doses (p=0.018).
Conclusion:
The results of this study support the use of higher loading and maintenance doses in patients presenting with TBI to reduce the incidence of posttraumatic seizures. Further studies are needed with stratification for injury severity and type of intracranial hemorrhage.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
Comparison of Dosing Strategies of Levetiracetam for Seizure Prophylaxis in Patients with Traumatic Brain Injury
Background/Significance:
Traumatic brain injury (TBI) affects around 1.7 million individuals annually in the United States and is associated with detrimental complications including seizures. Anticonvulsants are used prophylactically, with the 2024 Neurocritical Care Society Clinical Practice Guideline recommending levetiracetam as the preferred agent. However, no standardized dosing strategies currently exist, resulting in variability in both loading and maintenance of dose regimens across institutions and among providers. The aim of this project is to identify the most appropriate dosing strategy of levetiracetam to reduce seizure incidence in patients with TBI.
Purpose:
This project aimed to identify the most appropriate dosing strategy of levetiracetam to reduce seizure incidence in patients with TBI.
Methods:
This retrospective chart review compared different dosing strategies of levetiracetam for seizure prophylaxis at two institutions. It included patients admitted from 11/1/2020 through 8/1/2025 with a diagnosis of TBI who received levetiracetam during the initial 7 days following the injury. Those with history of seizures, prehospital use of anticonvulsants, seizure onset prior to medication administration, aneurysmal subarachnoid hemorrhage, or catastrophic brain injury with death within 48 hours were excluded from the study. The primary outcome was the incidence of seizures following TBI. Secondary outcomes included hospital and intensive care unit length of stay, need for rescue therapy due to seizures, and discontinuation rates due to adverse drug reactions. Data collected included the mechanism of injury, severity of brain injury, seizure type and method of diagnosis, dose of levetiracetam, duration of therapy, use of additional antiseizure drugs, adverse drug reactions, and disposition at discharge. This study was approved by the Institutional Review Board.
Results:
Out of the 3,718 patients screened, 825 met the inclusion criteria. Patients were divided into three groups based on loading doses: >20 mg/kg (n=276), <20 mg>/kg (n=209), or no loading dose (n=152). The incidence of seizures was 39 (14.1%), 54 (25.8%), and 19 (12.5%) respectively in these groups (p=0.001), with a higher incidence of early onset seizures in all groups. A subgroup analysis of maintenance dosing was performed and found that doses of 500 mg every 12 hours were associated with a higher incidence of seizure compared to higher doses (p=0.018).
Conclusion:
The results of this study support the use of higher loading and maintenance doses in patients presenting with TBI to reduce the incidence of posttraumatic seizures. Further studies are needed with stratification for injury severity and type of intracranial hemorrhage.
Affiliations
Advocate Lutheran General Hospital, Advocate Christ Medical Center