Lacosamide versus phenytoin for the prevention of early post traumatic seizures.

Purpose: To compare the efficacy and safety of lacosamide versus phenytoin for seizure prophylaxis following TBI.
Materials and Methods: All TBI patients who received prophylaxis with either phenytoin or lacosamide were retrospectively identified. The incidence of seizures within the first 7 days of injury were compared along with adverse effects requiring drug discontinuation. A planned sub-group analysis was performed for patients with severe TBI (GCS < 9).
Results: There were 481 patients (phenytoin, n = 116; lacosamide, n = 365). Demographics were similar but age (50 ± 21 vs 58 ± 22 years, P < .001) and initial GCS (11.3 ± 4.3 vs 12.5 ± 3.8, P = .010) were lower in the phenytoin group. The need for mechanical ventilation was higher (53% vs 38%, P = .004). Seizures occurred in 0.9% of the phenytoin group and 1.4% of the lacosamide group (P = 1.00). ADEs were significantly higher with phenytoin (5.2% vs 0.5%, P = .003). This difference remained significant upon multivariate analysis [OR(95% CI) = 9.4(1.8-48.9)]. Subgroup analysis for patients with severe TBI revealed no difference in seizures (phenytoin, 0% vs lacosamide, 1.5%; P = 1.00) but more ADEs with phenytoin (12.5% vs 0%, P = .010).
Conclusion: There was no difference between lacosamide and phenytoin in the prevention of early post traumatic seizures in patients following TBI. Lacosamide may have a more tolerable side effect profile.
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