Abstracts

Rationale: In the Columbia University Subarachnoid Hemorrhage Outcomes Project, subarachnoid hemorrhage complicated by a clinical seizure had an associated mortality of 65% at twelve months, and 89% if the seizure was only electrographically evident. At the same time, evidence from the same pool of patients indicates adverse outcomes associated with increased "phenytoin-burden". Because of its benign toxicity profile and ease of administration in a critically ill patient, intensive care specialists have been utilizing intravenous levetiracetam in the setting of subarachnoid hemorrhage. Methods: Retrospective chart review of patients admitted to the Neurosurgical Intensive Care Unit at the University of Colorado for subarachnoid hemorrhage between August 2006 and August 2007. Treatment with intravenous levetiracetam as adjunctive therapy to phenytoin or fosphenytoin for seizure prophylaxis was inclusion criteria. Seizure frequency, discharge disposition, and comparison of vital signs and serum chemistries pre and post treatment were assessed. Results: Thirty patients were collected that met inclusion criteria. A single seizure was reported in this group. Mean age was 51.6. Mean hospital stay was 21.8 days. Vital signs, serum electrolytes and hemotology values showed no clinically significant changes. Vasospasm was the most common complication of subarachnoid hemorrhage. No complications were directly attributable to intravenous levetiracetam. Conclusions: While seizure frequency is low in subarachnoid hemorrhage, its high mortality warrants prophylaxis. As evidence emerges that traditional prophylactic options are associated with both immediate complications as well as poor long term outcomes, intravenous levetiracetam deserves further study in this setting. Preliminary findings suggest no worsening of seizure frequency, hypotension, electrolyte or hematologic disturbances.