Preventive Effect of Phenytoin Compared to Levatiracetam on Incidence of Seizure in Children with Shunted Hydrocephalus

Background and purpose: Seizure in children with hydrocephalus is a common neurosurgical problem that may occur after shunting. This study aimed at comparing the preventive effect of phenytoin and levetiracetam in children with shunted hydrocephalus in a referral hospital. Materials and methods: All patients younger than 15 years of age who underwent ventriculoperitoneal (VP) shunt surgery for hydrocephalus (2016-2020) were included in this retrospective cohort study. The study was carried out in Nemazi Hospital, a referral center for pediatric neurosurgery in southwest Iran. Results: Seventy four patients received phenytoin and 47 received levetiracetam. There were no significant differences in patients’ mean age and sex (P= 0.753 and P= 0.851, respectively). In post-operation follow-up, 13 patients in the levetiracetam group and 10 patients in the phenytoin group developed seizure that showed a weakly significant difference between the two groups (P=0.046). Conclusion: According to this study, phenytoin had a better preventive effect on post-shunting seizures. In addition, due to known pharmacokinetics and pharmacodynamics of phenytoin, this antiepileptic drug may be a reasonable choice for seizure prophylaxis in first days after shunting in children with hydrocephalus.