Antiepileptics for seizure prophylaxis after traumatic brain injury

Torbic, Heather; Forni, Allison; Anger, Kevin E.; DeGrado, Jeremy; Greenwood, Bonnie C.

doi:10.2146/ajhp130439

Cited by 6 publications

(6 citation statements)

References 5 publications

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“…Phenytoin has been approved by the Food and Drug Administration for the control of generalized tonic–clonic and complex partial seizures and the prevention and treatment of seizures occurring during or after neurosurgery. [ 16 ] Our study showed a decreased tendency of seizures and abnormal EEG on follow-up with the use of levetiracetam. A number of studies reveal results in favor of levetiracetam owing to its relatively safer side effect profile and improved long-term outcomes.…”

Section: Discussionmentioning

confidence: 65%

Comparison of phenytoin versus levetiracetam in early seizure prophylaxis after traumatic brain injury, at a tertiary care hospital in Karachi, Pakistan

et al. 2018

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Aims:The aim of the study was to compare the efficacy of phenytoin and levetiracetam for seizure prophylaxis in patients with severe traumatic brain injury (TBI).Subjects and Methods:A randomized controlled trial was conducted over a period of 6 months, at a tertiary health care center in Karachi, Pakistan. Patients with TBI were divided into two groups. Patients in Group A were given phenytoin, whereas Group B patients received levetiracetam. The first dose of the drugs was given within 24 h of injury and continued for 7 days. Data were collected using a predesigned pro forma. All the patients who were in a state of persistent coma, had altered mental status, or had clinical signs of seizures underwent a 1-h electroencephalographic (EEG) recording to observe the seizures, the first EEG was done on the 1st day posttrauma and a second one was done on day 7 of drug use, both the EEGs were compared for changes. We also analyzed the patients according to their duration of antiepileptic drug therapy, length of hospital stay, and complications during therapy.Results:One hundred and forty (117 males and 23 females) patients who presented with TBI having a mean age of 29.48 ± 16.24 years were part of the study. The most prevalent cause of brain injury was road traffic accidents in 72.85% patients. There was no significant relationship between the antiepileptic drug used with the initial EEG (P = 0.313) and seizure activity (P = 0.502). However, a significant correlation of the antiepileptic drug used was found with EEG (P = 0.002) and seizure activity (P = 0.014) on follow-up. Patients who took levetiracetam had decreased the incidence of abnormal EEG and seizure activity on follow-up. There was not any correlation between GCS both initially (P = 0.845) and on follow-up (P = 0.104) with the antiepileptic drug used.Conclusion:The incidence of abnormal EEGs and seizure activity in patients with TBI is the same for both levetiracetam and phenytoin for the initial 7 days post-TBI; however, the incidence of seizures is lower for patients who used levetiracetam on the subsequent follow-up.

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Section: Discussionmentioning

confidence: 65%

Comparison of phenytoin versus levetiracetam in early seizure prophylaxis after traumatic brain injury, at a tertiary care hospital in Karachi, Pakistan

et al. 2018

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“…Regarding antiepileptic drugs, phenytoin and levetiracetam are the most common prophylactic agents used for post-TBI seizures, with phenytoin being recommended by the American Academy of Neurology for the prevention of early post-traumatic seizures [1,[22][23][24]. In our study, the most common antiepileptic agent used was indeed levetiracetam, followed by valproic acid and phenytoin.…”

Section: Strength and Limitationsmentioning

confidence: 76%

Young Age, Liver Dysfunction, and Neurostimulant Use as Independent Risk Factors for Post-Traumatic Seizures: A Multiracial Single-Center Experience

Oey

Tan

Pande

2023

IJERPH

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We aimed to determine the potentially modifiable risk factors that are predictive of post-traumatic brain injury seizures in relation to the severity of initial injury, neurosurgical interventions, neurostimulant use, and comorbidities. This retrospective study was conducted on traumatic brain injury (TBI) patients admitted to a single center from March 2008 to October 2017. We recruited 151 patients from a multiracial background with TBI, of which the data from 141 patients were analyzed, as 10 were excluded due to incomplete follow-up records or a past history of seizures. Of the remaining 141 patients, 33 (24.4%) patients developed seizures during long-term follow up post-TBI. Young age, presence of cerebral contusion, Indian race, low Glasgow Coma Scale (GCS) scores on admission, and use of neurostimulant medications were associated with increased risk of seizures. In conclusion, due to increased risk of seizures, younger TBI patients, as well as patients with low GCS on admission, cerebral contusions on brain imaging, and those who received neurostimulants or neurosurgical interventions should be monitored for post-TBI seizures. While it is possible that these findings may be explained by the differing mechanisms of injury in younger vs. older patients, the finding that patients on neurostimulants had an increased risk of seizures will need to be investigated in future studies.

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“…There are limited recommendations regarding phenytoin monitoring as well as data on the relationship between therapeutic phenytoin levels and a rate of early PTS. A total serum phenytoin concentration of 10–20 mcg/mL is a widely accepted target range to prevent seizures, but this has not been confirmed ( 22 ). Retrospective and randomized studies in patients with severe TBI have reported that 60–100% of patients who experience early PTS have therapeutic phenytoin levels ( 7 , 8 ).…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of early PTS after severe TBI while on prophylactic phenytoin ranges from 3 to 4% based on randomized and retrospective studies ( 5–7 , 22–24 ). In this study, the incidence of early PTS was higher at 13%.…”

Section: Discussionmentioning

confidence: 99%

Assessing risk factors associated with breakthrough early post-traumatic seizures in patients receiving phenytoin prophylaxis

Generoso,

Diep,

Hua

et al. 2024

Front. Neurol.

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ObjectivePost-traumatic seizure (PTS) is a well-known complication of traumatic brain injury (TBI). The objective of this study was to identify risk factors associated with breakthrough early PTS in TBI patients receiving phenytoin prophylaxis.MethodsThis was a single-centered retrospective study including adult patients admitted to the intensive care unit (ICU), had a TBI, and started on phenytoin for seizure prophylaxis within 24 h of admission. The primary outcome was the incidence and factors associated with early PTS, defined as a confirmed seizure on a continuous electroencephalogram within 7 days of TBI. Secondary outcomes included the association between early post-traumatic seizures and ICU length of stay, hospital length of stay, and in-hospital mortality.ResultsA total of 105 patients were included in the final analysis. Patients with early PTS were older (65 vs. 48 years old, p = 0.01), had a higher Marshall score (5 vs. 2, p = 0.01), were more likely to have a Marshall score > 2 (73 vs. 37%, p = 0.01), and had more neurosurgeries for hematoma evacuation (57 vs. 19%, p = 0.01). In patients with early PTS, 57% had a level at the time of seizure, and of those, 87.5% had a therapeutic level (>10 mcg/mL). Patients with early PTS had a longer ICU length of stay (14.7 vs. 5.9 days, p = 0.04) and a greater proportion of hospital mortality (21 vs. 2%, p = 0.02).ConclusionPatients with higher age, Marshall score, and neurosurgical procedures for hematoma evacuation had higher incidences of breakthrough early PTS despite the use of phenytoin prophylaxis. The majority of patients with early PTS had therapeutic phenytoin levels at the time of seizure when a level was available; however, approximately half (43%) did not have a level.

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Antiepileptics for seizure prophylaxis after traumatic brain injury

Cited by 6 publications

References 5 publications

Comparison of phenytoin versus levetiracetam in early seizure prophylaxis after traumatic brain injury, at a tertiary care hospital in Karachi, Pakistan

Comparison of phenytoin versus levetiracetam in early seizure prophylaxis after traumatic brain injury, at a tertiary care hospital in Karachi, Pakistan

Young Age, Liver Dysfunction, and Neurostimulant Use as Independent Risk Factors for Post-Traumatic Seizures: A Multiracial Single-Center Experience

Assessing risk factors associated with breakthrough early post-traumatic seizures in patients receiving phenytoin prophylaxis

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