Post-traumatic seizures (PTS) are seizures that follow traumatic brain injury (TBI). Survivors of TBI bear a tremendous burden of disability because of the secondary effects of TBI. PTS triggers secondary TBI through derangement in the acute physiology. Early PTS can be prevented. Yang and associates have shown that both levetiracetam and phenytoin are good choices for PTS prophylaxis. Phenytoin decreases the incidence of early PTS from 14.2% to 3.6% (p<0.001). However, it has many drawbacks. Levetiracetam is a broad-spectrum AED that is gaining widespread acceptance because it does not require monitoring and remarkably, it has a low rate of adverse effects. Its superiority over phenytoin for seizure prophylaxis in supratentorial brain tumours has been demonstrated by Pourzitaki et al. Nevertheless, the neurosurgeon is still faced with difficulty in deciding the appropriate seizure prophylaxis for TBI patients because the effectiveness of phenytoin versus levetiracetam is not well clarified