Safety and Efficacy of Levetiracetam for Prevention of Epileptic Seizures in Acute Phase of Intracerebral Bleeding

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Sheherbano Jadoon
Imran Ahmed
Ibrar Saleem
Jalil Khan
Anusha Pervaiz
Pir Mubassar Shah
Shah Faisal


Background: Epilepsy, characterized by recurrent, unprovoked seizures due to anomalous brain activity, is a significant complication for patients with intracerebral hemorrhage (ICH). The onset of epileptic convulsions during the acute phase of ICH can worsen the patient's prognosis and survival chances, making it crucial to identify a safe and effective method to prevent these seizures. Levetiracetam, a pyrrolidone derivative, is noted for its unique mechanism of action, exceptional tolerability, and advantageous pharmacokinetics, making it efficacious against various types of seizures.

Objective: This study aims to evaluate the safety and efficacy of levetiracetam in preventing epileptic seizures during the acute phase of ICH and to determine its impact on neurological outcomes in this patient population.

Methods: A cross-sectional investigation was conducted between October 2022 and June 2023 at Pak Emirates Military Hospital in Rawalpindi, Pakistan, involving 85 patients with spontaneous ICH confirmed by CT or MRI within 24 hours of symptom onset. Inclusion criteria included adult patients aged 18 or older, with various forms of ICH, excluding isolated subarachnoid hemorrhage, penetrating wound injury, depressed skull fracture, or early posttraumatic seizure. Patients with a Glasgow Coma Scale (GCS) score of less than 6, serum creatinine level >1.7 mg/dL, history of psychosis, unprovoked seizures, cerebrovascular accidents, traumatic brain injuries, or encephalitis within the previous three years were excluded. Patients were administered an initial loading dose of levetiracetam (1,000 to 1,500 mg), followed by a maintenance dose (500 to 1,500 mg every 12 hours) based on renal function. Continuous electroencephalography (cEEG) monitoring was used to detect seizures for at least the first 72 hours of hospital admission. The primary outcome was the incidence of epileptic seizures during hospitalization, while the secondary outcome was the patient's neurological status at discharge, assessed using the Modified Rankin Scale (mRS). Data were analyzed using descriptive statistics and the Chi-square test, with a p-value of ≤0.05 considered statistically significant. Analyses were conducted using SPSS version 25.

Results: The mean age of the patients was 47.89 years (SD=7.46), with 62.35% male and 37.65% female. The mean GCS score at admission was 10.52 (SD=2.13), and the mean volume of ICH was 17.5 ml (SD=3.4). At baseline, 2.35% of patients had GCS scores of 3-5, which improved to 0% after treatment. The percentage of patients with GCS scores of 13-15 increased from 65.88% to 83.52% (p=0.3730). Seizures within the first 7 days occurred in 10.58% of patients, and the overall seizure incidence during hospitalization was 20%. At discharge, 9.41% of patients had an mRS score of 0, and the percentage of patients with an mRS score of 2 increased significantly from 18.18% to 37.64% (p=0.4086*). The percentage of patients with severe disability (mRS score of 5) significantly decreased from 22.72% to 5.68% (p=0.0094*).

Conclusion: Levetiracetam is effective in improving neurological outcomes and reducing the incidence of seizures in patients with acute intracerebral hemorrhage, with a manageable safety profile. These findings suggest that levetiracetam can be a valuable addition to therapeutic strategies for managing ICH-related seizures, potentially enhancing patient care and improving health outcomes.

Article Details

How to Cite
Jadoon, S., Ahmed, I., Saleem, I., Khan, J., Pervaiz, A., Shah, P. M., & Faisal, S. (2024). Safety and Efficacy of Levetiracetam for Prevention of Epileptic Seizures in Acute Phase of Intracerebral Bleeding. Journal of Health and Rehabilitation Research, 4(2), 690–695.
Author Biographies

Sheherbano Jadoon, Pak Emirates Military Hospital Rawalpindi Pakistan.

Pak Emirates Military Hospital Rawalpindi, Pakistan.

Imran Ahmed, Pak Emirates Military Hospital Rawalpindi Pakistan.

Professor Neurology, Pak Emirates Military Hospital Rawalpindi, Pakistan.

Ibrar Saleem, Pak Emirates Military Hospital Rawalpindi Pakistan.

Trainee Neurology, Pak Emirates Military Hospital Rawalpindi, Pakistan.

Jalil Khan, Pak Emirates Military Hospital Rawalpindi Pakistan.

Trainee Neurology, Pak Emirates Military Hospital Rawalpindi, Pakistan.

Anusha Pervaiz, Pak Emirates Military Hospital Rawalpindi Pakistan.

Trainee Neurology, Pak Emirates Military Hospital Rawalpindi, Pakistan.

Pir Mubassar Shah, Pak Emirates Military Hospital Rawalpindi Pakistan.

Trainee Neurology, Pak Emirates Military Hospital Rawalpindi, Pakistan.

Shah Faisal, Pak Emirates Military Hospital Rawalpindi Pakistan.

Trainee Neurology, Pak Emirates Military Hospital Rawalpindi, Pakistan.


Anwar H, Khan QU, Nadeem N, Pervaiz I, Ali M, Cheema FF. Epileptic Seizures. Discoveries (Craiova). 2020;8(2):e110. doi: 10.15190/d.2020.7.

Strein M, Holton-Burke JP, Smith LR, Brophy GM. Prevention, Treatment, and Monitoring of Seizures in the Intensive Care Unit. J Clin Med. 2019;8(8):1177. doi: 10.3390/jcm8081177.

Surges R, Volynski KE, Walker MC. Is Levetiracetam Different From Other Antiepileptic Drugs? Levetiracetam and Its Cellular Mechanism of Action in Epilepsy Revisited. Ther Adv Neurol Disord. 2008;1(1):13-24. doi: 10.1177/1756285608094212.

Rincon F, Mayer SA. Clinical Review: Critical Care Management of Spontaneous Intracerebral Hemorrhage. Crit Care. 2008;12:237. doi: 10.1186/cc7092.

Rajashekar D, Liang JW. Intracerebral Hemorrhage. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available from:

Sødal HF, Storvig G, Tverdal C, Robinson HS, Helseth E, Taubøll E. Early Post-Traumatic Seizures in Hospitalized Patients With Traumatic Brain Injury. Acta Neurol Scand. 2022;146(5):485-491. doi: 10.1111/ane.13670.

Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, Hemphill JC, Johnson R, Keigher KM, Mack WJ, Mocco J, Newton EJ, Ruff IM, Sansing LH, Schulman S, Selim MH, Sheth KN, Sprigg N, Sunnerhagen KS. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2022;53:407. doi: 10.1161/STR.0000000000000407.

Fordington S, Manford M. A Review of Seizures and Epilepsy Following Traumatic Brain Injury. J Neurol. 2020;267(10):3105-3111. doi: 10.1007/s00415-020-09926-w.

Hinduja A. Posterior Reversible Encephalopathy Syndrome: Clinical Features and Outcome. Front Neurol. 2020;11:71. doi: 10.3389/fneur.2020.00071.

Jain S, Iverson LM. Glasgow Coma Scale. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available from:

Pingue V, Mele C, Biscuola S, Nardone A, Bagnato S, Franciotta D. Impact of Seizures and Their Prophylaxis With Antiepileptic Drugs on Rehabilitation Course of Patients With Traumatic or Hemorrhagic Brain Injury. Front Neurol. 2022;13:1060008. doi: 10.3389/fneur.2022.1060008.

Askew RL, Capo-Lugo CE, Sangha R, Naidech A, Prabhakaran S. Trade-Offs in Quality-of-Life Assessment Between the Modified Rankin Scale and Neuro-QoL Measures. Value Health. 2020;23(10):1366-1372. doi: 10.1016/j.jval.2020.06.011.

Lee H, Mizrahi MA, Hartings JA, Sharma S, Pahren L, Ngwenya LB, Moseley BD, Privitera M, Tortella FC, Foreman B. Continuous Electroencephalography After Moderate to Severe Traumatic Brain Injury. Crit Care Med. 2019;47(4):574-582. doi: 10.1097/CCM.0000000000003639.

Abou-Khalil B. Levetiracetam in the Treatment of Epilepsy. Neuropsychiatr Dis Treat. 2008;4(3):507-523. doi: 10.2147/ndt.s2937.

Gupta V, Gupta K, Singh G, Kaushal S. An Analytical Study to Correlate Serum Levels of Levetiracetam With Clinical Course in Patients With Epilepsy. J Neurosci Rural Pract. 2016;7(Suppl 1):S31-S36. doi: 10.4103/0976-3147.196445.

An SJ, Kim TJ, Yoon BW. Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update. J Stroke. 2017;19(1):3-10. doi: 10.5853/jos.2016.00864.

Klein P, Herr D, Pearl PL, Natale J, Levine Z, Nogay C, Sandoval F, Trzcinski S, Atabaki SM, Tsuchida T, van den Anker J, Soldin SJ, He J, McCarter R. Results of Phase 2 Safety and Feasibility Study of Treatment With Levetiracetam for Prevention of Posttraumatic Epilepsy. Arch Neurol. 2012;69(10):1290-1295. doi: 10.1001/archneurol.2012.445.

Kreimer AM, Littrell RA, Gibson JB, Leung NR. Effectiveness of Levetiracetam as a First-Line Anticonvulsant for Neonatal Seizures. J Pediatr Pharmacol Ther. 2019;24(4):320-326. doi: 10.5863/1551-6776-24.4.320.

ElHabr AK, Katz JM, Wang J, Bastani M, Martinez G, Gribko M, Hughes DR, Sanelli P. Predicting 90-Day Modified Rankin Scale Score With Discharge Information in Acute Ischemic Stroke Patients Following Treatment. BMJ Neurol Open. 2021;3(1):e000177. doi: 10.1136/bmjno-2021-000177.

Thompson MP, Mat R. Abstract 168: Assessing the Utility of the Modified Rankin Scale (mRS) at Discharge to Predict Day 90 Outcomes in Acute Stroke Registries. Circulation. 2012;5:A168.

Asuzu D, Nystrom K, Amin H, et al. Modest Association Between the Discharge Modified Rankin Scale Score and Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis. J Stroke Cerebrovasc Dis. 2015;24:548-553. doi: 10.1016/j.jstrokecerebrovasdis.2014.09.034.