Research Reports - Antiseizure prophylaxis after traumatic brain injury does not decrease seizure rates but may inhibit functional recovery

J Trauma Acute Care Surg. 2014 Jan;76(1):54-60

Bhullar IS, Johnson D, Paul JP, Kerwin AJ, Tepas JJ 3rd, Frykberg ER

BACKGROUND: The purposes of this study were to examine the current Brain Trauma
Foundation recommendation for antiseizure prophylaxis with phenytoin during the
first 7 days after traumatic brain injury (TBI) in preventing seizures and to
determine if this medication affects functional recovery at discharge.
METHODS: The records of adult (age ≥ 18 years) patients with blunt severe TBI who
remained in the hospital at least 7 days after injury were retrospectively
reviewed from January 2008 to January 2010. Clinical seizure rates during the
first 7 days after injury and functional outcome at discharge were compared for
the two groups based on antiseizure prophylaxis, no prophylaxis (NP) versus
phenytoin prophylaxis (PP). Statistical analysis was performed using χ2.
RESULTS: A total of 93 adult patients who met the previously mentioned criteria
were identified (43 [46%] NP group vs. 50 [54%] PP group). The two groups were
well matched. Contrary to expectation, more seizures occurred in the PP group as
compared with the NP group; however, this did not reach significance (PP vs. NP,
2 [4%] vs. 1 [2.3%], p = 1). There was no significant difference in the two
groups (PP vs. NP) as far as disposition are concerned, mortality caused by head
injury (4 [8%] vs. 3 [7%], p = 1), discharge home (16 [32%] vs. 17 [40%], p =
0.7), and discharge to rehabilitation (30 [60%] vs. 23 [53%], p = 0.9). However,
with PP, there was a significantly longer hospital stay (PP vs. NP, 36 vs. 25
days, p = 0.04) and significantly worse functional outcome at discharge based on
Glasgow Outcome Scale (GOS) score (PP vs. NP, 2.9 vs. 3.4, p < 0.01) and modified
Rankin Scale score (2.3 ± 1.7 vs. 3.1 ± 1.5, p = 0.02).
CONCLUSION: PP may not decrease early posttraumatic seizure and may suppress
functional outcome after blunt TBI. These results need to be verified with
randomized studies before recommending changes in clinical practice and do not
apply to penetrating trauma.
LEVEL OF EVIDENCE: Therapeutic study, level IV; epidemiologic study, level III.

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