This randomized study supports earlier indications that the anti-seizure medication levetiracetam, marketed as Keppra, was as effective at preventing seizures as the traditional medication, phenytoin, marketed as Dilantin, while producing fewer negative side effects. Patients treated with Keppra also had improved long-term outcomes, the researchers found.
The study will be published in the April 2010 issue of the journal,Neurocritical Care; it appeared online on Nov. 7, 2009.
The study of anti-seizure medications in the neuroscience intensive care unit (NSICU) at UC Health University Hospital is part of a focused, ongoing effort to harness scientific evidence to improve treatments and outcomes for patients. Seizures are common following severe brain injury, and minimizing or eliminating them is a primary objective of neurocritical care.
The study was led by Lori Shutter, MD, associate professor of neurosurgery and neurology and director of neurocritical care at UCNI. The published article was written by co-investigator Jerzy Szaflarski, MD, PhD, associate professor of neurology.
“We continue to make incremental, meaningful strides in the care of patients who are hospitalized in the NSICU following subarachnoid hemorrhage or traumatic brain injury,” Shutter says. (A subarachnoid hemorrhage, a type of bleeding stroke, occurs when blood seeps into the subarachnoid space between the brain and the skull.)
Dilantin has traditionally been the standard of care in preventing seizures, which afflict 25 to 30 percent of patients who have suffered a traumatic brain injury or subarachnoid hemorrhage. Keppra is an established anti-seizure medication given to people with epilepsy (defined as having more than one seizure), but its effectiveness for preventing seizures in patients after a brain injury had not been proven. The study sought to establish the drug’s safety and effectiveness in this group of patients.
Although the number of patients in the study was small (52), the results appear to be an indicator that Keppra might be an appropriate alternative to Dilantin for preventing seizures and improving outcomes of patients who have suffered a traumatic brain injury or subarachnoid hemorrhage.
“Preventing seizures is a critical part of protecting a patient’s brain from further injury following trauma or stroke,” Szaflarski says. Seizures in the neurocritical care setting can result in aneurysm rupture, increased pressure on the brain, oxygen deprivation, physical injury and death. Seizures can be visible (overt), or undetectable to the human eye (covert).
Despite being the standard of care in the neurocritical care setting, Dilantin is linked to many serious and harmful side effects, including medication interactions, rash, fever, low blood pressure, heart arrhythmias, toxicity and organ abnormalities. Previously, the UCNI team, led by Szaflarski, had reported that patients in the NSICU who were treated with Keppra or whose medication was switched to Keppra had fewer complications and shorter hospital stays than those who continued treatment with Dilantin.
This experience led to the newly published study, which compared the safety of Keppra to that of Dilantin and compared the drugs’ effect on seizure activity and long-term outcomes. Patients enrolled in the study underwent continuous EEG monitoring for up to 72 hours. EEG, which stands for electroencephalogram, produces a recording of electrical activity in the brain. Two-thirds of the patients were randomly assigned to receive Keppra, while one-third were randomly assigned to receive Dilantin. The physicians were blinded to which medication the patient received.
The results showed that while patients experienced the same outcomes relating to seizure activity and survival, those treated with Keppra suffered fewer side effects and had better long-term outcomes when examined at three- and six-month intervals following their hospital discharge.
Shutter notes that the study results had an immediate impact on research protocols for other studies in the NSICU that were not allowing use of Keppra. After this study, the protocols were modified to allow Keppra’s use.
Michael Privitera, MD, professor of neurology and director of the UC Epilepsy Center, points to the Keppra study as an example of UCNI’s expansion of clinical and research projects associated with the continuous monitoring for seizures in the NSICU. In 2009 more than 200 critically ill patients were monitored in an effort to quantify overt and covert seizures, including life-threatening status epilepticus, a state of continuous brain seizure activity.
“Rapid and accurate detection of seizure activity leads to treatment that can protect nerve cells from damage, especially in cases of subarachnoid hemorrhage or traumatic brain injury,” Privitera says. “All of the neurologists and neurointensivists have been trained to perform the initial interpretations of EEG tracings, and our epilepsy staff can verify and read the EEG remotely. University Hospital is the only hospital in the Tristate area with this capability.”
The importance of the Keppra study’s publication was acknowledged this month, when the article was selected for inclusion in London-based Faculty of 1000 Medicine (www.f1000medicine.com), a literature-awareness service whose mission is to identify and evaluate “the most important articles published in Medicine.” Recommendations come from a faculty of more than 2,000 researchers and clinicians.
Jane Hunter, managing director of Faculty of 1000, stated that the article’s identification and inclusion provides recognition “of its scientific merit and the positive contribution it makes to the medical literature.”
Shutter and Szaflarski have received grant support from UCB Pharma, Inc., the manufacturer of Keppra. Szaflarski has served as a paid consultant and/or speaker for UCB, Inc.
Cindy Starr | EurekAlert!
WAKE-UP provides new treatment option for stroke patients | International study led by UKE
17.05.2018 | Universitätsklinikum Hamburg-Eppendorf
First form of therapy for childhood dementia CLN2 developed
25.04.2018 | Universitätsklinikum Hamburg-Eppendorf
So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics
Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...
The historic first detection of gravitational waves from colliding black holes far outside our galaxy opened a new window to understanding the universe. A...
A team led by Austrian experimental physicist Rainer Blatt has succeeded in characterizing the quantum entanglement of two spatially separated atoms by observing their light emission. This fundamental demonstration could lead to the development of highly sensitive optical gradiometers for the precise measurement of the gravitational field or the earth's magnetic field.
The age of quantum technology has long been heralded. Decades of research into the quantum world have led to the development of methods that make it possible...
Cardiovascular tissue engineering aims to treat heart disease with prostheses that grow and regenerate. Now, researchers from the University of Zurich, the Technical University Eindhoven and the Charité Berlin have successfully implanted regenerative heart valves, designed with the aid of computer simulations, into sheep for the first time.
Producing living tissue or organs based on human cells is one of the main research fields in regenerative medicine. Tissue engineering, which involves growing...
A team of scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg investigated optically-induced superconductivity in the alkali-doped fulleride K3C60under high external pressures. This study allowed, on one hand, to uniquely assess the nature of the transient state as a superconducting phase. In addition, it unveiled the possibility to induce superconductivity in K3C60 at temperatures far above the -170 degrees Celsius hypothesized previously, and rather all the way to room temperature. The paper by Cantaluppi et al has been published in Nature Physics.
Unlike ordinary metals, superconductors have the unique capability of transporting electrical currents without any loss. Nowadays, their technological...
02.05.2018 | Event News
13.04.2018 | Event News
12.04.2018 | Event News
18.05.2018 | Power and Electrical Engineering
18.05.2018 | Information Technology
18.05.2018 | Information Technology