Comparing the safety and efficacy of sodium valproate, levetiracetam, and phenytoin in attenuating the severity of agitation in patients with post-traumatic brain injury: An observational study

by Shivani Singh, Raghavendra Nayak, Shivaprakash Gangachannaiah, Ashutosh Bhosale, Reena Sherin Parveen, Varun Kumar S G, Geeta Sundar Objective The present study aimed to compare the safety and efficacy of sodium valproate, levetiracetam, and phenytoin in agitation control. Methods and Material This prospective observational study included 189 adult patients with traumatic brain injury (TBI) receiving sodium valproate, phenytoin, and levetiracetam.

Agitation was monitored using the Richmond Agitation-Sedation Scale (RASS) at baseline and serially over seven days. The study evaluated the percentage of patients who experienced agitation-relief (A-R) following antiepileptic drugs, along with pattern of adverse events among the three groups.

Results Sodium valproate (sod.v) demonstrated better efficacy with 85.7% of patients achieving A-R compared to 63.5% in levetiracetam (P = 0.016). The median time to achieve A-R was 3 days in sod.v and significantly lesser compared to 4 days in phenytoin (P = 0.04) and 5 days in levetiracetam (P = 0.0001).

By day 4, 72% of patients in the sod.v achieved A-R, in contrast to 50% in the phenytoin and 31.7% in the levetiracetam group.