Levetiracetam vs No Antiseizure Prophylaxis in Mild Traumatic Brain Injury

Introduction: Data supporting the use of seizure prophylaxis are limited in mild traumatic brain injury (mTBI), and the role of antiseizure medication (ASM), including levetiracetam (LEV) remains unclear. This study aims to evaluate the effect of LEV compared to no ASM prophylaxis on outcomes in mTBI.


Methods: This was a single-center retrospective cohort study at a Level I trauma center of patients admitted between June 2022 and Dec 2023. Included patients had an admission GCS of 13-15 and at least one ICU day. Patients who received LEV for ≥2 days within 48 hours of admission were compared to those who received no ASM for prophylaxis. The primary outcome was discharge disposition. Secondary outcomes included discharge GCS, in-hospital mortality, ICU and hospital LOS, and seizure incidence.


Results: Of the 301 patients included, 135 were in the LEV group and 166 in the no ASM group. Patients were predominantly male (68.4%) with a mean age of 61.1 years. Falls were the most common mechanism of injury (50%). Notably, the LEV group had a significantly higher median Injury Severity Score (17 vs. 12, p < 0.001), more subdural hematoma (44.4% vs. 30.1%, p = 0.010), and underwent neurosurgical intervention more frequently (21.5% vs. 3.0%, p < 0.001). Extracranial injuries were more prevalent in the no ASM group (63.7% vs. 61.4%, p= 0.687). There was no difference in discharge disposition, with most patients discharged to home or home health (63.0% vs. 63.9%, p = 0.873). Median GCS at discharge was 15 [IQR 14–15] in the LEV group vs. 15 [IQR 15–15] in the no ASM group (p < 0.001). The LEV group received more medications with antiseizure effects (70.4% vs. 48.2%, p < 0.001) and more medications known to lower seizure threshold (45.2% vs. 27.7%, p = 0.001). ICU LOS (6.3 vs. 3.2 days, p < 0.001) and hospital LOS (11 vs. 6.6 days, p = 0.002) were longer in the LEV group. There were more seizures in the LEV group (3.7% vs 0, p = 0.017). There was no difference in in-hospital mortality (3.7% vs. 1.8%, p = 0.255).


Conclusions: LEV prophylaxis was not associated with a more favorable discharge disposition to home or home health in patients with mTBI. Patients receiving LEV had longer hospital and ICU stays, suggesting that LEV may be used in more severely ill patients.