Levetiracetam Treatment in Traumatic Brain Injury: Operation Brain Trauma Therapy

Megan Browning, Deborah A. Shear, Helen Bramlett, C. Edward Dixon, Stefania Mondello, Kara E. Schmid, Samuel M. Poloyac, W. Dalton Dietrich, Ronald L. Hayes, Kevin K W Wang, John T. Povlishock, Frank C. Tortella, Patrick M. Kochanek

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Levetiracetam (LEV) is an antiepileptic agent targeting novel pathways. Coupled with a favorable safety profile and increasing empirical clinical use, it was the fifth drug tested by Operation Brain Trauma Therapy (OBTT). We assessed the efficacy of a single 15 min post-injury intravenous (IV) dose (54 or 170 mg/kg) on behavioral, histopathological, and biomarker outcomes after parasagittal fluid percussion brain injury (FPI), controlled cortical impact (CCI), and penetrating ballistic-like brain injury (PBBI) in rats. In FPI, there was no benefit on motor function, but on Morris water maze (MWM), both doses improved latencies and path lengths versus vehicle (p <0.05). On probe trial, the vehicle group was impaired versus sham, but both LEV treated groups did not differ versus sham, and the 54 mg/kg group was improved versus vehicle (p <0.05). No histological benefit was seen. In CCI, there was a benefit on beam balance at 170 mg/kg (p <0.05 vs. vehicle). On MWM, the 54 mg/kg dose was improved and not different from sham. Probe trial did not differ between groups for either dose. There was a reduction in hemispheric tissue loss (p <0.05 vs. vehicle) with 170 mg/kg. In PBBI, there was no motor, cognitive, or histological benefit from either dose. Regarding biomarkers, in CCI, 24 h glial fibrillary acidic protein (GFAP) blood levels were lower in the 170 mg/kg group versus vehicle (p <0.05). In PBBI, GFAP blood levels were increased in vehicle and 170 mg/kg groups versus sham (p <0.05) but not in the 54 mg/kg group. No treatment effects were seen for ubiquitin C-terminal hydrolase-L1 across models. Early single IV LEV produced multiple benefits in CCI and FPI and reduced GFAP levels in PBBI. LEV achieved 10 points at each dose, is the most promising drug tested thus far by OBTT, and the only drug to improve cognitive outcome in any model. LEV has been advanced to testing in the micropig model in OBTT.

Original languageEnglish (US)
Pages (from-to)581-594
Number of pages14
JournalJournal of Neurotrauma
Volume33
Issue number6
DOIs
StatePublished - Mar 15 2016

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Keywords

  • biomarker
  • controlled cortical impact
  • excitotoxicity
  • fluid percussion
  • Keppra
  • neuroprotection
  • penetrating ballistic-like brain injury
  • post-traumatic seizures
  • rat
  • therapy

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Browning, M., Shear, D. A., Bramlett, H., Dixon, C. E., Mondello, S., Schmid, K. E., Poloyac, S. M., Dalton Dietrich, W., Hayes, R. L., Wang, K. K. W., Povlishock, J. T., Tortella, F. C., & Kochanek, P. M. (2016). Levetiracetam Treatment in Traumatic Brain Injury: Operation Brain Trauma Therapy. Journal of Neurotrauma, 33(6), 581-594. https://doi.org/10.1089/neu.2015.4131