Abstract Details

Title A Prospective Study of Optimal Dosing Strategies of Levetiracetam for Seizure Prophylaxis in Critically Ill Patients

Topic Neuro Trauma and Critical Care

Presentation(s) S4 - Neurocritical Care (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Background The use of prophylactic anticonvulsants among neurocritically ill patients has been controversial. Variable results in studies of prophylactic levetiracetam may be due, in part, to underdosing and failure to obtain therapeutic levels.

Objective Determine the dose of prophylactic levetiracetam (fixed and mg/kg dose) that most consistently generates therapeutic trough levels (12–46 μg/ml).

Design/Methods A prospective cohort study was conducted. Consecutive adult neurocritical care patients that received levetiracetam for seizure prophylaxis between 7/2019-7/2022 were included. Patients with history of seizure, anti-epileptic drug use or renal failure requiring dialysis were excluded. Serum samples were collected prior to administration of the 4th dose. Levetiracetam doses were determined by the treating physician.

Results A total of 206 patients were evaluated (median age 64 years [range 15-89]; 46% female). Indications for seizure prophylaxis included traumatic brain injury (N=97, 47%), spontaneous subarachnoid hemorrhage (N=48, 23%), supratentorial neurosurgery (N=43, 21%), and ICH (N=18, 9%). The most common loading dose was 1000 mg (79% of patients, range 500-3000 mg) and the most common maintenance dose was 500 mg BID (52% of patients, range 500-2000 BID). Non-therapeutic levels occurred in 94 (46%) patients. Of the patients that received 500mg (N=106), 750mg (N=46), and ≥1000mg (N=52) maintenance doses, subtherapeutic levels occurred in 55%, 30%, 38%, respectively. Patients who received 1000 mg BID (median 11 mg/kg/dose) had the highest percentage of therapeutic levels (64%). A maintenance dose of 500 mg BID (median 7 mg/kg/dose) was associated with a likelihood ratio of 6.7 for subtherapeutic levels (P=0.035).

Conclusions Over 50% of patients who received 500 mg BID (7 mg/kg/dose) maintenance levetiracetam dosing had subtherapeutic levels, while 1000 mg BID (11 mg/kg/dose) was more likely to generate therapeutic levels.

Authors/Disclosures
Eduard H. Valdes, MD (Columbia University Irving Medical Center) PRESENTER	Dr. Valdes has received research support from a T32 NIH Grant.
Taolin Fang, MD (Cedars-Sinai Medical Center - Los Angeles, CA UNITED STATES - Los Angeles, CA)	Dr. Fang has nothing to disclose.
Jennifer A. Frontera, MD (NYU Langone Health)	Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving as a Consultant for FirstKindMedical. Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Physician Education Resource. The institution of Dr. Frontera has received research support from NIH. The institution of Dr. Frontera has received research support from Alexion. Dr. Frontera has received publishing royalties from a publication relating to health care.