Comparisons Of Efficacy Of Levetiracetam Versus Phenytoin For Seizure Prophylaxis In Patients With Brain Injury-a Meta Analysis

Objective:To systematically review the efficacy,side effects and mortality rate of LEV versus PHT for seizure prophylaxis of brain injured patients.Method:Related randomized controlled trials of high quality about LEV versus PHT 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 Rev Man 5.3 software according to strict inclusion and exclusion criteria.Results:13 English articles were finally included.2529 patients were obtaind 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 that of 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 were not statistically significant differences(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 on the mortality rate of patients performed 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]).Conclusion:Levetiracetam and Phenytoin demonstrate equal efficacy in seizure prevention after brain injury,the effect estimate remained insignificant about the side effect,the mortality rate and the length of stay.But Adverse drug reactions requiring change in therapy occurred more in PHT,the differences were statistically significant.Phenytoin still remains the drug of choice based on the existing evidence.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 the subject were found.larger prospective trials are warranted.