Abstracts

Rationale: Seizures occur in 7-25% of patients with subarachnoid hemorrhage (SAH) and are a major contributor to poor outcome. Phenytoin (PHT) is often in these patients for either prophylaxis or treatment of seizures; however its use is challenging due to side effects, a narrow therapeutic range, nonlinear pharmacokinetics, and frequent monitoring of free/total level. Levetiracetam (LEV) does not have many of the pharmacologic challenges of PHTMethods: Patients admitted to Duke University Medical Center between January 1st 2002 and June 30th 2006 with SAH were reviewed; those treated with PHT or LEV were enrolled. Efficacy and tolerability of PHT and LEV were determined by the occurrence of seizures or side effects necessitating a change of medication. These were compared with a Chi-square test between the PHT and LEV groups. This study was approved by the local Institutional Review Board.Results: A total of 176 patients with SAH were identified; all were initially treated with PHT. In 70 (39.8%) patients, PHT replaced with LEV. While on PHT, 5 (2.8%) patients had seizures; none of these patients had seizure while on LEV (p=.14). Another 56 (31.8%) patients were switched to LEV due to intolerance; 23 (13.1%) had elevated transaminase, 21 (11.9%) had thrombocytopenia, 9 (5.1%) had unexplained fever, and 3 (1.7%) developed a rash. Of those 70 patients on LEV, none had intolerance leading to a change of medication (p<0.001). Conclusions: LEV appears to be at least comparably effective compared to PHT in controlling seizures in patients with SAH. However LEV appears to have superior tolerability. (Acknowledgement: This study was funded in part by UCB Pharmaceuticals.)