Seizure prophylaxis is crucial since having an episode post TBI increases the risk for developing epilepsy. About half of patients with a severe TBI will have a seizure within 24 hours.
Risk factors include decreased GCS, skull fractures, penetrating injuries, and retained material. Increased metabolic demands, increased intracranial pressure, compromised cerebral oxygen delivery, and excess neurotransmitter release.
Post traumatic seizures are classified under two categories; early is within seven days, and late is after. Seizure prophylaxis is not beneficial and may do harm in late post traumatic seizures. There isn’t a preference on guideline recommended options, but fosphenyoin 17-20 mg/kg and levetiracetem 500 to 1000 mg or weight-based are reasonable treatments.
Levetiracetem seems more practical with most trauma patients since it can be given as an IV push and without concerns for DDI in the setting of limited information.
References
Carney et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017 Jan 1;80(1):6-15.
Lucke-Wold et al. Traumatic brain injury and epilepsy: Underlying mechanisms leading to seizure. Seizure. 2015 Dec;33:13-23.
Temkin, N. Risk factors for posttraumatic seizures in adults. Epilepsia. 2003;44(s10):18-20.
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