Prophylactic Treatment of Posttraumatic Epilepsy: Results of a Long‐Term Foliow‐Up in Czechoslovakia

Servít, Z; Musil, F

doi:10.1111/j.1528-1157.1981.tb04115.x

Cited by 62 publications

(23 citation statements)

References 5 publications

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“…[11][12][13][15][16][17][18][19] In three cases, the studies also addressed the issue of early seizures within the same cohort of patients [11][12][13] ; in one case late seizures were assessed in a subset of the cohort studied for early seizures. 16 Two randomized placebo-controlled trials with masked assessment, both evaluating phenytoin, were graded class I.…”

Section: Does Aed Prophylaxis Decrease the Risk Of Developing Late Sementioning

confidence: 99%

Practice parameter: Antiepileptic drug prophylaxis in severe traumatic brain injury

Chang¹,

Lowenstein²

2003

Neurology

293

129

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Abstract-Objective:To review the evidence regarding antiepileptic drug (AED) prophylaxis in patients with severe traumatic brain injury (TBI) in order to make practice recommendations. Methods: The authors identified relevant studies by searching multiple databases and reviewing reference lists of other sources. They included studies that prospectively compared post-traumatic seizure rates in patients given AED prophylaxis vs controls. Each study was graded (class I to IV) according to a standard classification-of-evidence scheme and results were analyzed and pooled. Results: Pooled class I studies demonstrated a significantly lower risk of early post-traumatic seizures (those occurring within 7 days after injury) in patients given phenytoin prophylaxis compared to controls (relative risk 0.37, 95% CI 0.18 to 0.74). Pooled class I and class II studies demonstrated no significant difference in the risk of late post-traumatic seizures (those occurring beyond 7 days after injury) in patients given AED prophylaxis compared to controls (relative risk 1.05, 95% CI 0.82 to 1.35). Serum AED levels were suboptimal in these studies and adverse effects were mild but frequent. Conclusions: For adult patients with severe TBI, prophylaxis with phenytoin is effective in decreasing the risk of early post-traumatic seizures. AED prophylaxis is probably not effective in decreasing the risk of late post-traumatic seizures. Further studies addressing milder forms of TBI, the use of newer AEDs, the utility of EEG, and the applicability of these findings to children are recommended.

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Section: Does Aed Prophylaxis Decrease the Risk Of Developing Late Sementioning

confidence: 99%

Practice parameter: Antiepileptic drug prophylaxis in severe traumatic brain injury

Chang¹,

Lowenstein²

2003

Neurology

293

129

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“…These studies all showed a trend toward a reduced probability of seizures in the treated groups, in which seizures developed in 0 to 10 percent of patients compared with 2 to 50 percent in untreated groups. The only combination treatment, PB + PHT, showed a marked difference between the treated (2%) and untreated (25%) groups [11].…”

Section: Results Of Observational Studies For Prophylaxismentioning

confidence: 99%

“…The AEDs used are phenobarbital (PB) + PHT [11], PHT [12][13], PB [14], and valproic acid (VPA) [15]. Each study included 62 to 390 patients with follow-up periods from 6 months to 13 years.…”

Section: Results Of Observational Studies For Prophylaxismentioning

confidence: 99%

Posttraumatic epilepsy and treatment

Chen

Ruff

Eavey

et al. 2009

JRRD

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Abstract-Posttraumatic epilepsy (PTE) is a major long-term complication of traumatic brain injury (TBI). PTE usually develops within 5 years of head injury. The risk for developing PTE varies with TBI type. Both Korean and Vietnam war veterans with penetrating TBI had a 53% risk of developing PTE. The risk of developing PTE is between 10% and 25% in combat-associated closed-head trauma with positive brain imaging and about 5% in moderately severe closed-head injury without imaging finding. We do not know the risk of PTE among Operation Iraqi Freedom/Operation Enduring Freedom veterans with minimal TBI because of blast exposure. Partial seizures may manifest with subtle behavioral alterations that can be mistaken for manifestations of posttraumatic stress disorder and improperly treated. Accidents and medical complications commonly occur during seizures. Sudden unexpected death in epilepsy is most frequent among 20-to 40-year-olds. Seizures increase the likelihood of refractory seizures years after TBI. Seizures are also a social stigma that compromise veterans' reintegration into society. People with uncontrolled epilepsy are not allowed to drive and have difficulty obtaining or maintaining employment. Optimal seizure control is essential to the physical and emotional health of veterans with TBI and to their ability to lead productive lives.

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“…it was observed that, as focal seizures recurred, there was an increasing tendency for the interval between attacks to grow shorter, and for minor attacks to lead to major ones (Burnham, 1991). It has also been reported that Jacksonian and post-traumatic seizures in humans often develop progressively more severe clinical manifestations over time (Wada, 1977;Servit and Musil, 1981). The increase seen in seizure frequency presumably relates to a drop in focal thresholds.…”

Section: The Development Of Low Seizure Thresholdmentioning

confidence: 99%