Use of antiepileptics for seizure prophylaxis after traumatic brain injury
UMass Chan Affiliations
Pharmacy DepartmentDocument Type
Journal ArticlePublication Date
2013-05-01Keywords
AnticonvulsantsSeizures
Brain Injuries
Nervous System Diseases
Neurology
Pharmacy and Pharmaceutical Sciences
Metadata
Show full item recordAbstract
PURPOSE: Antiepileptics used for seizure prophylaxis after traumatic brain injury (TBI) are reviewed. SUMMARY: Of the 275,000 people who are hospitalized with TBI each year, approximately 5-7% experience a posttraumatic seizure (PTS). According to the latest guidelines issued by the Brain Trauma Foundation and the American Academy of Neurology (AAN) for the management of severe TBI, PTS prophylaxis is recommended only during the first seven days after TBI. Of the available antiepileptic drugs, phenytoin has been the most extensively studied for the prophylaxis of PTS. Phenobarbital, valproate, and carbamazepine have not been as extensively researched, and, given their adverse-effect profiles and pharmacodynamic properties, there is no advantage to using these agents over phenytoin. Levetiracetam has demonstrated comparable efficacy to phenytoin for PTS prophylaxis and is associated with fewer adverse effects and monitoring considerations; it may be a reasonable alternative to phenytoin. However, levetiracetam has been associated with an increased seizure tendency. The Brain Trauma Foundation recommends using phenytoin for early PTS prophylaxis. The guidelines also state that valproate has demonstrated similar efficacy to phenytoin but warn that its use may be associated with increased mortality. CONCLUSION: The available literature supports the use of antiepileptics for early PTS prophylaxis during the first week after a TBI. Phenytoin has been extensively studied for this indication and is recommended by the AAN and Brain Trauma Foundation guidelines for early PTS prophylaxis. Levetiracetam has demonstrated comparable efficacy to phenytoin for early PTS prophylaxis and may be a reasonable alternative to consider in this patient population.Source
Am J Health Syst Pharm. 2013 May 1;70(9):759-66. doi: 10.2146/ajhp120203. Link to article on publisher's siteDOI
10.2146/ajhp120203Permanent Link to this Item
http://hdl.handle.net/20.500.14038/30149PubMed ID
23592358Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.2146/ajhp120203