The Effect of Antiseizure Medication Administration on Mortality and Early Posttraumatic Seizures in Critically Ill Older Adults with Traumatic Brain Injury

Glaser, Adam C.; Kanter, John H.; Martínez‐Camblor, Pablo; Taenzer, Andreas H.; Anderson, Matt V.; Buhl, Lauren K; Shaefi, Shahzad; Pannu, Ameeka; Boone, M. Dustin

doi:10.1007/s12028-022-01531-1

Cited by 9 publications

(7 citation statements)

References 23 publications

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“…In fact, only 1 patient (2.6%) had electrographic seizures following PB loading, which is significantly lower than what was reported by Ritter and Colleagues (10.8%) and similar to that reported by Glaser and Colleagues (4.7%). 2,27 Our cohort of patients met several of the documented risk factors for early PTS as 20.5% had a 24hour best GCS ≤8 and roughly 70% of patients had subarachnoid or subdural hemorrhages. 2,3 The rate of early PTS at our institution over a 16-year period in patients treated with conventional ACP was recently reported as 4.6%, which is similar to that reported in our study (2.6%).…”

Section: Discussionmentioning

confidence: 97%

Phenobarbital as Anticonvulsant Prophylaxis in Patients With Traumatic Brain Injury at Risk for Alcohol Withdrawal Syndrome

McGinnis

Wang

Chiappelli

et al. 2023

Journal of Pharmacy Practice

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Background: Anticonvulsant prophylaxis (ACP) for early post-traumatic seizures (PTS) is recommended in patients with traumatic brain injury (TBI). Phenobarbital (PB) may be used to prevent alcohol withdrawal syndrome (AWS) in at-risk patients. The dual-purpose use of PB in the TBI population would allow for consolidation of pharmacotherapy. Objective: The primary objective of this study was to determine the frequency of early PTS in TBI patients at risk of AWS treated with PB as ACP. Secondary objectives included determining rates of over sedation and endotracheal intubation. Methods: Patients received an intravenous (IV) loading dose of PB at 15-20 mg/kg followed by 1 mg/kg every 12 hours for 7 days with a goal level of 15-20 mcg/mL. Medication data, seizure frequency, and episodes of over sedation and endotracheal intubation were collected. Results: Eighty patients were treated with PB over a 1-year period. Thirty-nine patients were analyzed. Median loading dose was 19.9 (Interquartile Range 19.1-20.0) mg/kg with a median post load level of 21.7 mcg/mL (IQR 18.3-25.8) mcg/mL. One patient (2.6%) had electrographic evidence for early PTS. PB was discontinued in 4 (10.3%) patients out of concern for over sedation. One patient required endotracheal intubation after rapid PB loading. Conclusion: The frequency of early PTS was low when PB was used as primary ACP in patients with TBI at risk for AWS. Over sedation is a potential adverse effect that should be considered in the choice of ACP. No conclusions can be drawn as to the effectiveness of PB in preventing AWS.

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Section: Discussionmentioning

confidence: 97%

Phenobarbital as Anticonvulsant Prophylaxis in Patients With Traumatic Brain Injury at Risk for Alcohol Withdrawal Syndrome

McGinnis

Wang

Chiappelli

et al. 2023

Journal of Pharmacy Practice

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“…We excluded 1 study with a null effect that did not include patients who had seizures during the first 24 hours after trauma. The first day after trauma is the most common time for early PTS, with at least two-thirds of early PTS occurring during the first 24 hours .…”

Section: Discussionmentioning

confidence: 99%

“…For example, some studies excluded seizures occurring during the first 24 hours after trauma (ie, immediate seizure) from analysis . The first 24 hours after injury is the most common time to have an early PTS and may be a period where prophylaxis is most effective …”

Section: Methodsmentioning

confidence: 99%

“…A priori, our plan was to include patient-level data. 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 …”

Section: Methodsmentioning

confidence: 99%

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Early Seizure Prophylaxis in Mild and Moderate Traumatic Brain Injury

Pease,

Mittal,

Merkaj

et al. 2024

JAMA Neurol

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ImportanceGuidelines recommend seizure prophylaxis for early posttraumatic seizures (PTS) after severe traumatic brain injury (TBI). Use of antiseizure medications for early seizure prophylaxis after mild or moderate TBI remains controversial.ObjectiveTo determine the association between seizure prophylaxis and risk reduction for early PTS in mild and moderate TBI.Data SourcesPubMed, Google Scholar, and Web of Science (January 1, 1991, to April 18, 2023) were systematically searched.Study SelectionObservational studies of adult patients presenting to trauma centers in high-income countries with mild (Glasgow Coma Scale [GCS], 13-15) and moderate (GCS, 9-12) TBI comparing rates of early PTS among patients with seizure prophylaxis with those without seizure prophylaxis.Data Extraction and SynthesisThe Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) reporting guidelines were used. Two authors independently reviewed all titles and abstracts, and 3 authors reviewed final studies for inclusion. A meta-analysis was performed using a random-effects model with absolute risk reduction.Main Outcome MeasuresThe main outcome was absolute risk reduction of early PTS, defined as seizures within 7 days of initial injury, in patients with mild or moderate TBI receiving seizure prophylaxis in the first week after injury. A secondary analysis was performed in patients with only mild TBI.ResultsA total of 64 full articles were reviewed after screening; 8 studies (including 5637 patients) were included for the mild and moderate TBI analysis, and 5 studies (including 3803 patients) were included for the mild TBI analysis. The absolute risk reduction of seizure prophylaxis for early PTS in mild to moderate TBI (GCS, 9-15) was 0.6% (95% CI, 0.1%-1.2%; P = .02). The absolute risk reduction for mild TBI alone was similar 0.6% (95% CI, 0.01%-1.2%; P = .04). The number needed to treat to prevent 1 seizure was 167 patients.Conclusion and RelevanceSeizure prophylaxis after mild and moderate TBI was associated with a small but statistically significant reduced risk of early posttraumatic seizures after mild and moderate TBI. The small absolute risk reduction and low prevalence of early seizures should be weighed against potential acute risks of antiseizure medications as well as the risk of inappropriate continuation beyond 7 days.

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“…[20][21][22] There is evidence demonstrating a mortality bene t of early ASM administration in older adults (age 65 and older) with TBI, suggesting that early ASM may provide a mortality bene t in other conditions where patients are predisposed to seizures, non-convulsive status epilepticus (NCSE), and DCI. 23 The nding that the early ASM group had a higher OR for seizure when compared to the non-prophylaxis group may indicated that ASM administration was intended for treatment of seizure or seizure-like activity seen at presentation rather than true prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Antiseizure Medication on Mortality in Spontaneous Aneurysmal Subarachnoid Hemorrhage

Kanter,

Glaser,

Martinez-Camblor

et al. 2024

Preprint

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Background Spontaneous aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of morbidity and mortality in the United States. The efficacy of early antiseizure medication (ASM) is debated. Recent literature reports seizure rates ranging from 7.8% to 15.2% following spontaneous aSAH. Current guidelines recommend use of early ASM in patients with “high-risk features,” but whether early ASM use decreases the rate of death associated with aSAH remains unclear. This study assessed whether early administration of early ASM impacts mortality rates after spontaneous aSAH. Methods We conducted a retrospective cohort study using a publicly available dataset from the Massachusetts Institute of Technology, Medical Information Mart for Intensive Care-III (MIMIC) database of all patients over the age of 18 with spontaneous aSAH resulting in an intensive care unit (ICU) admission to a major United States trauma center from 2001 to 2012. The primary exposure was receiving early ASM and primary outcome of death within 7 days. Different regression models were created to explore the association between early ASM administration within 24 hours of admission and a composite outcome of seizure and/or death within 7 days of admission. Secondary outcomes included 30-day and one-year mortality. Results Of 253 patients with spontaneous aSAH, 148 received early ASM within 24 hours. Patients who did not receive early ASM were more likely to die within 7 days of admission (adjusted odd ratio, [aOR]: 0.25 95% CI 0.09 to 0.067; P=0.006) but were less likely to have a seizure (aOR: 7.65 95% CI 2.03 to 28.89). Conclusion Early ASM administration was associated with lower rates of seizure and/or death within 7 days of admission among patients who presented to an ICU with spontaneous aSAH. These findings suggest broader use of early ASM in patients who present with spontaneous aSAH may improve early mortality.

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The Effect of Antiseizure Medication Administration on Mortality and Early Posttraumatic Seizures in Critically Ill Older Adults with Traumatic Brain Injury

Cited by 9 publications

References 23 publications

Phenobarbital as Anticonvulsant Prophylaxis in Patients With Traumatic Brain Injury at Risk for Alcohol Withdrawal Syndrome

Phenobarbital as Anticonvulsant Prophylaxis in Patients With Traumatic Brain Injury at Risk for Alcohol Withdrawal Syndrome

Early Seizure Prophylaxis in Mild and Moderate Traumatic Brain Injury

The Effect of Antiseizure Medication on Mortality in Spontaneous Aneurysmal Subarachnoid Hemorrhage

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