IV Keppra in the Emergency Department for Prevention of Early Recurrent Seizures

Inclusion Criteria: * age 18 or older * patient presenting to Grady Memorial Hospital's Emergency Department after having a tonic-clonic seizure (primary or secondarily generalized) within the last 4 hours Cause of seizure for inclusion: reason for seizure is often undetermined at time of presentation to the Emergency Department. The most likely expected causes of a seizure are noncompliance to existing antiepileptic drug regimen, refractory epilepsy with breakthrough seizure, metabolic aberration, alcohol withdrawal, or unknown. Exclusion Criteria: * non-English speaking * first time seizure * seizures other than tonic-clonic seizure (primary or secondarily generalized) * more than 3 seizures in 24 hours or status epilepticus, pregnant patients by history or by urine pregnancy testing, serious neurologic insult resulting in seizure but where seizure is not the primary reason for admission (e.g. traumatic brain injury with seizure or hemorrhagic stoke would be excluded) * contraindication to IV levetiracetam * received IV phenytoin within 24 hours * known allergy to phenytoin * previously enrolled in the study