The use of antiepileptic medication in early post traumatic seizure prophylaxis at a single institution

Candy, Nicholas; Tsimiklis, Chrisovalantis; Poonnoose, Santosh; Trivedi, Riki

doi:10.1016/j.jocn.2019.07.066

Cited by 14 publications

(19 citation statements)

References 16 publications

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“…Pada studi Retrospective case-note yang dilakukan Candy dkk. (Candy, et al,2019) didapatkan sebanyak 2124 pasien dipulangkan dari pusat studi dengan hematoma intrakranial selama masa studi Mei 2013 hingga Juni 2017. 1496 pasien dikeluarkan karena etiologi hematoma non-trauma, dan 18 pasien dikeluarkan karena memiliki PTS sebelumnya.…”

Section: Karakteristik Partisipanunclassified

“…Pada studi yang dilakukan Candy dkk. (Candy, et al, 2019) sebanyak 102 pasien diresepkan profilaksis AED, sementara 508 pasien tidak diresepkan profilaksis apa pun. Pada 508 pasien yang tidak diresepkan profilaksis, total 18 pasien (3,5%) memiliki PTS dini.…”

Section: Hasil Dari Literatur Yang Digunakanunclassified

“…Penggunaan OAE sebagai profilaksis dapat menurunkan kejadian PTS pada pasien dengan TBI sedang atau berat. Pada penelitian yang dilakukan Candy dkk pada pasien dengan TBI sedang atau berat dan menerima OAE sebagai profilaksis menunjukkan kejadian PTS yang lebih rendah dibandingkan dengan pasien yang tidak diberikan OAE, yaitu 3,5% kejadian PTS sedangkan pada pasien yang tidak diberi OAE kejadi PTS sebanyak 8,6% (Candy, et al, 2019) Fenitoin merupakan agen profilaksis kejang yang banyak digunakan pada kasuskasus TBI di fase awal dan PTS. Cara kerjanya dengan memberikan efek di korteks motoric dengan mengeluarkan natrium dari neuron sehingga dapat menstabilkan hipereksitabilitas.…”

Section: Pembahasanunclassified

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Penggunaan Antikejang Pada Cedera Kepala: Tinjauan Sistematis

Zafira

Kemuning

Sholihah

et al. 2022

JSF

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Brain injury can occur due to direct head impact and injury due to brain tissue damage such as hypotension, hypoxia, acidosis and edema. Brain injury will trigger an inflammatory process that can lead to post-trauma seizures. The use of anti- epileptic drugs is intended as a seizure prophylaxis so that it can reduce the incidence of seizures in the early phase of injury. Quantify the effectivity of anti seizure usage on post traumatic seizure accident. The method used in this paper is a relevant systematic review from various references and focuses on the use of analgesics for the management of seizures due to brain injury. The literature search used PubMed and found 7 literature that met the criteria. Consists of 1 RCT study and 6 observational studies. Prophylactic therapy in the incidence of head injury is effective in preventing PTS. The use of anti seizure can be given to patients with moderate or severe TBI and can be given less than 12 hours after injury to prevent seizures. Prophylactic therapy is only recommended for 7 days after head injury. Anti seizure drug which is often used as a prophylactic agent are phenytoin and levetiracetam. Lacosamide is recommended for users with refractory status epilepticus. Levetiracetam has fewer side effects than phenytoin and lacosamide, so the use of this drug is preferable to use.Using Anti seizure in cases of post-traumatic brain injury (TBI) or post traumatic seizure (PTS) is behoof as a seizure prophylactic attempt by using recommendation less than eight days because OAE has been shown several side effects, include increasing mortality. Especially for using phenytoin and lacosamide, it is necessary to monitor

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Penggunaan Antikejang Pada Cedera Kepala: Tinjauan Sistematis

Zafira

Kemuning

Sholihah

et al. 2022

JSF

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“…[ 22 ] Few studies have specifically evaluated early PTS in mild TBI and existing studies are flawed by their retrospective nature, single-center nature, or lack of randomization. [ 4 , 7 , 14 , 18 ] Despite the lack of data for the benefit of prophylactic AEDs, many practitioners routinely prescribe prophylactic AEDs for mild TBI. [ 13 , 14 , 19 ]…”

Section: Introductionmentioning

confidence: 99%

“…[ 16 ] The incidence of PTS among all mild TBI patients, defined as TBI with a GCS of 13–15, is reported ranging from 0.3% to upward of 4%. [ 4 , 15 , 17 ] Patients with a positive computed tomography (CT) head scan may have increased risk for early PTS, making prophylactic AEDs more effective.…”

Section: Introductionmentioning

confidence: 99%

Multicenter and prospective trial of anti-epileptics for early seizure prevention in mild traumatic brain injury with a positive computed tomography scan

Pease

Zaher

Lopez

et al. 2022

Surgical Neurology International

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Background: Posttraumatic seizures (PTSs) are a major source of disability after traumatic brain injury (TBI). The Brain Trauma Foundation Guidelines recommend prophylactic anti-epileptics (AEDs) for early PTS in severe TBI, but high-quality evidence is lacking in mild TBI. Methods: To determine the benefit of administering prophylactic AEDs, we performed a prospective and multicenter study evaluating consecutive patients who presented to a Level 1 trauma center from January 2017 to December 2020. We included all patients with mild TBI defined as Glasgow Coma Scale (GCS) 13–15 and a positive head computed tomography (CT). Patients were excluded for previous seizure history, current AED use, or a neurosurgical procedure. Patients were given a prophylactic 7-day course of AEDs on a week-on versus week-off basis and followed with in-person clinic visits, in-hospital evaluation, or a validated phone questionnaire. Results: Four hundred and ninety patients were enrolled, 349 (71.2%) had follow-up, and 139 (39.8%) were given prophylactic AEDs. There was no difference between seizure rates for the prophylactic AED group (0.7%) and those without (2.9%; P = 0.25). Patients who had a PTS were on average older (81.4 years) than patients without a seizure (64.8 years; P = 0.02). Seizure rate increased linearly by age groups: <60 years old (0%); 60–70 years old (1.7%); 70–80 years old (2.3%); and >80 years old (4.6%). Conclusion: Prophylactic AEDs did not provide a benefit for PTS reduction in mild TBI patients with a positive CT head scan.

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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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The use of antiepileptic medication in early post traumatic seizure prophylaxis at a single institution

Cited by 14 publications

References 16 publications

Penggunaan Antikejang Pada Cedera Kepala: Tinjauan Sistematis

Penggunaan Antikejang Pada Cedera Kepala: Tinjauan Sistematis

Multicenter and prospective trial of anti-epileptics for early seizure prevention in mild traumatic brain injury with a positive computed tomography scan

Early Seizure Prophylaxis in Mild and Moderate Traumatic Brain Injury

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