Post-Traumatic Seizure Prophylaxis After Mild Traumatic Brain Injury: Analysis of Practice Patterns
Abstract number :
996
Submission category :
7. Antiepileptic Drugs / 7E. Other
Year :
2020
Submission ID :
2423329
Source :
www.aesnet.org
Presentation date :
12/7/2020 1:26:24 PM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Jovany Cruz Navarro, Baylor College of Medicine; Gretchen Brophy - Virginia Commonwealth University; Nancy Temkin - University of Washington; Jason Barber - University of Washington; Micheal Strein - Virginia Commonwealth University; Brandon Foreman - Uni
Rationale:
Post-traumatic seizures (PTS) are a long-recognized complication of traumatic brain injury (TBI). While current guidelines recommend a 7-day course of PTS prophylaxis after severe TBI, evidence to guide PTS prophylaxis after mild TBI is lacking. The purpose of this study is to examine the practice patterns of PTS prophylaxis among different centers, the incidence of early and late PTS and post-traumatic epilepsy (PTE) after mild-TBI, and to determine whether antiepileptic drug (AED) administration is effective in the prevention of PTS and PTE after mild-TBI.
Method:
Patients in the prospectively collected TRACK-TBI network database who met the following criteria were included: Glasgow Coma Score 13-15, age > 17 years, no prior history of seizures or epilepsy, and no prior use of medications that lower seizure threshold medications. Patients received either phenytoin, levetiracetam or fosphenytoin for PTS prophylaxis.
Results:
A total of 1451 patients admitted to 18 major academic centers met inclusion criteria. 564 (39%) subjects received PTS prophylaxis at some point during the hospital stay (AED-group), while 887 (61%) did not receive PTS prophylaxis (non-AED group). Patient demographics were similar between groups, with mean GCS on admission of 14.6 (SD 0.5, AED group) vs. 14.8 (SD 0.7, non-AED group). PTS prophylaxis administration was widely variable between centers (ranging from 7 to 71%). Seventy three percent of subjects in the AED-group had a positive CT head scan for any degree of intracranial lesion on admission versus twenty seven percent in the non-AED group. The incidence of PTS was 5% (n=31) in the AED group vs. 1% (n=9) in the non-AED group. No significant difference on PTS incidence was found when comparing between AED administered.
Conclusion:
As hypothesized, wide variability regarding AED prescription exists among treatment centers given the lack of established guidelines for PTS prophylaxis after mild-TBI. The main drivers for AED administration appear to be the presence of an intracranial lesion on admission imaging and the academic center of practice.
Funding:
:TRACK-TBI Network
Antiepileptic Drugs