• Pavel Klein, Daniel Herr, Phillip L Pearl, JoAnne Natale, Zachary Levine, Claude Nogay, Fabian Sandoval, Stacey Trzcinski, Shireen M Atabaki, Tammy Tsuchida, John van den Anker, Steven J Soldin, Jianping He, and Robert McCarter.
• Department of Neurology, MedStar Research Institute, Washington, DC, USA. kleinp@epilepsydc.com
• Arch. Neurol. 2012 Oct 1;69(10):1290-5.

ObjectivesTo evaluate the safety and tolerability of treatment with levetiracetam and determine the trough levels of levetiracetam in patients with traumatic brain injury (TBI) who are at high risk for posttraumatic epilepsy (PTE).DesignOpen-label, nonrandomized phase 2 study with 2 arms comparing levetiracetam treatment vs observation.SettingTwo level 1 trauma centers.PatientsA total of 422 participants 6 years or older with TBI who have a 20% risk for PTE were screened. Of these participants, 205 (48.6%) were eligible. A total of 126 participants were enrolled: 86 adults and 40 children. A total of 66 participants were in the treatment group (46 adults and 20 children), and a total of 60 participants were in the observation group (40 adults and 20 children). Participants presenting within 8 hours after TBI received treatment, and those presenting more than 8 to 24 hours after TBI did not.InterventionTreatment with levetiracetam (55 mg/kg/d) for 30 days starting within 8 hours after injury.Main Outcome MeasuresNumber of adverse events, mood score, number of infections, trough level of levetiracetam, and PTE.ResultsOf the 66 participants treated with levetiracetam, 2 (3%) stopped treatment owing to toxicity (somnolence). The most common adverse events were fatigue, headache, and somnolence. Mood scores and number of infections did not differ between the treatment and observation groups. Mean trough levels of levetiracetam on days 2 to 30 ranged from 19.6 to 26.7 μg/mL. At 2 years, 13 of 86 adults (15.1%) and 1 of 40 children (2.5%) developed PTE. At 2 years, 5 of 46 treated adults (10.9%) and 8 of 40 untreated adults (20.0%) developed PTE (relative risk, 0.47; P=.18).ConclusionTreatment with 55 mg/kg/d of levetiracetam (a dose with an antiepileptogenic effect on animals) for patients with TBI at risk for PTE is safe and well tolerated, with plasma levels similar to those in animal studies. The findings support further evaluation of levetiracetam treatment for the prevention of PTE.Trial Registrationclinicaltrials.gov Identifier: NCT01463033.

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