Seizure Prevention in Traumatic Brain Injury With Levetiracetam and Lacosamide

Inclusion Criteria:

* 18 years and older
* Diagnosis of traumatic brain injury: severe, moderate, or mild with high-risk imaging features
* Seizure prophylaxis with one of the two study drugs within 24 hours of initial injury
* Patients admitted into the trauma team service

Exclusion Criteria:

* Enrolled in another interventional drug study
* Any active, witnessed, or unable to rule out seizure prior to prophylaxis initiation
* Received antiseizure medication (ASM), for prophylaxis or treatment, prior to randomization
* History of seizures
* On anti-epileptic medications for seizures or indications other than seizures prior to admission
* Documented history of alcohol withdrawal and experiencing alcohol withdrawal on admission with initiation of clinical institute withdrawal assessment scale revised (CIWA-Ar) or modified Minnesota Detoxification Scale (mMINDS) requiring treatment
* Spinal cord injury (SCI), confirmed by radiographic imaging demonstrating cervical (C1 to C8) or thoracic-spine (T1 to T12) injuries consistent with spinal cord injury
* History of bradycardia or permanent pacemaker or signs of bradycardia with HR \< 55 bpm for \> 5 min not on medications that cause bradycardia
* End-stage renal disease (ESRD)
* Death, withdrawal of life support or transfer to hospice within 24 hours
* Pregnant or incarcerated
* Baseline GCS \< 13 or unable to determine baseline GCS
* Patient with a GCS of 15 or Legally Authorize Representative (LAR) unable to provide informed consent prior to randomization, or unable to read and understand English, Spanish, Vietnamese, Russian, Arabic, or French