Effectiveness of antiseizure medications therapy in preventing seizures in brain injury patients: A network meta-analysis

Abstract

Purpose: To explore the effectiveness of different anti-seizure medications in preventing early and late post-traumatic epilepsy (PTE). The efficacy, treatment-related side-effects, and mortality of the different treatments were compared using a ranking model to identify the optimal treatment. Methods: A comprehensive literature search was performed using Pubmed, Medline, Embase, and Cochrane library databases. All relevant published articles up to 10 March 2022 were evaluated. The quality of the extracted data was assessed using either the Cochrane risk of bias tool or the Newcastle-Ottawa scale. The primary outcome measures were early or late post-traumatic seizures. The secondary outcome measures were mortality, treatmentrelated adverse effects, length of hospital stay, and length of stay within the intensive care unit (ICU).Results: A total of seven randomized controlled trials and 18 non-randomized controlled trials were included in this network meta-analysis. The trials included six interventions: Phenytoin (PHT)+phenobarbital (PB), levetiracetam (LEV), PHT, PHT-LEV, lacosamide (LCM), and valproate (VPA). All interventions except VPA significantly reduced the rate of early PTE in TBI patients compared with the placebo. Seven studies reported the impact of four treatments (PHT + PB, LEV, PHT, VPA) on late seizures and showed a significant reduction in the incidence of late seizures in patients with TBI

Prognostic Implications of Early Prediction in Posttraumatic Epilepsy

“…The use of newer generation prophylactic antiseizure medications, for example, remains an intervention with an unclear degree of efficacy. 81,82 Given the novelty of prognostic models for PTE, there is currently no data to suggest how patient surrogates would utilize these tools to inform their decisions, or at what point they should be deployed. With any new tool, it comes with the risk that patient surrogates may actually utilize the information provided to them in an unpredictable manner.…”

Initial clinical evidence on biperiden as antiepileptogenic after traumatic brain injury. A Randomized Clinical Trial

“…The lack of true AED in clinical use is far from being associated with a lack of research toward that end. However, considering that most PTE studies present observational research design and lack reporting the incidence of late seizures (Huo et al, 2022), together with differences in PTE definition and classification of TBI severity, among others, raises multiple barriers to the breakthrough in the field (Thompson et al, 2015). So, specific funding from many kinds of organizations, and research efforts led by groups of investigators have not been able to bring new therapeutic options (for a review see French et al, 2021).…”