Preventing epilepsy after traumatic brain injury: A propensity score analysis

Abstract

Background: Due to the potential consequences of post-traumatic epilepsy (PTE) exacerbating secondary injury following traumatic brain injury (TBI), the use of antiepileptic drugs (AEDs) is an accepted option for seizure prophylaxis. However, there is only a paucity of data that can be found regarding outcomes surrounding the use of AEDs. The purpose of this retrospective study is to evaluate whether the prophylactic administration of AEDs significantly decreased the incidence of PTE, when considering the severity of TBI. Methods: All trauma patients who had been newly diagnosed with TBI from January 1, 2010 to December 31, 2017 were retrospectively analyzed. Statistical comparisons were made using the chi-square test, Mann-Whitney U test, and Cox regression modeling. After excluding any exposed subjects with no appropriate match, patients who had received AED prophylaxis were matched by propensity score with those who did not receive AEDs. All of the TBI populations were followed up until June 30, 2018. Results: We identified 1316 patients who met the inclusion and exclusion criteria in our matched cohort through their propensity scores, where 138 patients had been receiving prophylactic AEDs and 138 patients had not. Baseline characteristics were similar in gender, age, Glasgow Coma Scale (GCS) scores, and risk factors of PTE including skull fracture, chronic alcoholism, subdural hematoma, epidural hematoma, and intracerebral hematoma. After adjusting for those risk factors, the relative incidence of seizure was not statistically significant in either of the groups ( p = 0.566). Conclusion: In our cohort analysis, AED prophylaxis was ineffective in preventing seizures, as the rate of seizures was similar whether patients had been receiving the drugs or not. We therefore concluded that the benefits of routine prophylactic anticonvulsant therapy in patients with TBI need to be re-evaluated.

Early Seizure Prophylaxis in Mild and Moderate Traumatic Brain Injury

“…One-half of the studies reported patients with mild and moderate TBI separately . Most studies, except for 2, had significantly more (>80%) mild TBI than moderate (Table 1).…”

“…Overall, all the studies were graded as good quality on the NOS (Table 2). Common reasons for decreased quality were only including patients at rehabilitation hospitals and failure to provide adequate follow-up information or descriptions of patients lost to follow-up …”

“…Unfortunately, the large majority of studies were unable to share data because contact emails were no longer active, data were not available, or groups were unwilling to share data . Due to our difficulty getting patient-level data, we decided to only include studies that reported data stratified by trauma severity using Glasgow Coma Scale (GCS) or were willing to share that that data with us …”

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

“…Based on the different mechanisms of the different ASMs and the limitation of the available evidence, the use of ASMs for the prevention of epileptic seizures after TBI is still controversial. A propensity score analysis conducted by Liou et al ( Liou et al, 2020 ). Revealed that ASMs were ineffective in preventing seizures after TBI, and the benefit of routine prophylactic ASMs treatment in TBI patients needs to be reassessed ( Saletti et al, 2019 ).…”

“…Depending on the location and severity of the bleeding, PTE can occur immediately within 24 h after trauma, early within the first 7 days following trauma, and late after 7 days following trauma ( Turnbull et al, 2016 ; Chartrain et al, 2017 ). Over the past 30 years, the cumulative incidence of PTE was 2% for mild brain injury, 4% for moderate brain injury, and 15% for severe brain injury ( Saletti et al, 2019 ; Liou et al, 2020 ). PTE following TBI may further exacerbate the effects of TBI on memory and cognition, damage the cerebrovascular system or blood-brain barrier, and lead to depression or post-traumatic stress disorder ( Castriotta et al, 2007 ; Luo et al, 2014 ; Muccigrosso et al, 2016 ; Vos et al, 2018 ).…”