Severity-Dependent Efficacy of Seizure Prophylaxis in Traumatic Brain Injury
Abstract number :
1.311
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2025
Submission ID :
1050
Source :
www.aesnet.org
Presentation date :
12/6/2025 12:00:00 AM
Published date :
Authors :
Isaac Thorman, ScM – New York Medical College
Presenting Author: Ariel Sacknovitz, MS – New York Medical College
Austin Li, MS – New York Medical College
Michael Schubert, PT, PhD – Johns Hopkins University School of Medicine, Baltimore, Maryland
Carrie Muh, MD – Maria Fareri Children’s Hospital and Westchester Medical Center
Patricia McGoldrick, NP – New York Medical College
Steven M Wolf, MD – Westchester Medical Center, Hawthorne, NY, United States
Fawaz Al-Mufti, MD – Westchester Medical Center
Rationale: Traumatic brain injury (TBI) affects 369 per 100,000 Americans each year, resulting in 69,000 deaths. Epilepsy is a common sequelae of TBI, and while anti-seizure medications (ASMs) such as levetiracetam are often given prophylactically to prevent short-term epilepsy, there is little consensus regarding their effect on subsequently long-term developing epilepsy.
Methods: Patients from the TriNetX Research Network were included based on the first incidence of a TBI when ≥18 years old in their medical record. Patients were excluded if they had a history of seizures, epilepsy, or levetiracetam prior to TBI or did not have Glasgow Coma Scale (GCS) recorded on the day of TBI. GCS was used to categorize patients into mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS 3-8) TBI. Patients were classified based on whether they received levetiracetam or no ASM on the day of TBI. Cox proportional hazard models assessed whether levetiracetam compared to no ASMs were associated with a decrease in epilepsy development in the short term (7 days) and long term (1 year). Due to the database time resolution, patients with seizures or epilepsy on the day of TBI were excluded to ensure that levetiracetam was administered as prophylaxis. Models were adjusted for age, intracranial pathology, surgical interventions, epilepsy risk factors, and other patient management parameters. Patients were followed for up to five years to assess for adverse effects of levetiracetam regardless of whether they had GCS recorded.
Results: We identified 1,336,084 adult patients with a TBI and no history of epilepsy, of which 47,282 had GCS recorded on the day of TBI. Of these, 69% were mild, 8% were moderate, and 26% were severe. Patients receiving levetiracetam had increased frequencies of short-term epilepsy development in mild (6.6% vs. 1.9%, p< 0.0001), moderate (12.1% vs. 5.2%, p< 0.0001), and severe (11.5% vs. 5.1%, p< 0.0001) TBIs. After adjustment, levetiracetam was protective against early epilepsy in severe TBI (HR=0.545; 95% CI: 0.306, 0.969; p=0.039) but not mild TBI (HR=0.848; 95% CI: 0.447, 1.610; p=0.614). In contrast, levetiracetam did not provide significant long-term protection in mild (HR=1.001; 95% CI: 0.787, 1.271; p=0.997) or severe (HR=0.897; 95% CI: 0.676, 1.190; p=0.450) TBIs. Older ages, cerebral edema, and subdural hemorrhage were consistently identified as risk factors for post-traumatic epilepsy at all levels. Adverse effects significantly elevated in levetiracetam compared to no ASM included metabolic disorders, impaired memory/awareness, visual disturbances, diabetes mellitus, and thrombocytopenia.
Clinical Epilepsy