Seizure Prophylaxis in Young Patients Following Traumatic Brain Injury
Ahmed Abdel-Aziz Bahey, Talat Chughtai, Ayman El-Menyar, Vishwajit Verma, Gustav Strandvik, Mohammad Asim, Rafael Consunji, Basil Younis, Ashok Parchani, Sandro Rizoli, Hassan Al-Thani- Emergency Medicine
Abstract
Introduction:
Phenytoin is one of the commonly used anti-seizure medications in nontraumatic seizures. However, its utility and safety in young patients with traumatic brain injury (TBI) for the prevention of early-onset seizures (EOS) are debatable. We sought to explore the use of phenytoin as a seizure prophylaxis following TBI. We hypothesized that administering phenytoin is not effective in preventing EOS after TBI.
Methods:
This was a retrospective observational study conducted on adult TBI patients. EOS was defined as a witnessed seizure within a week postinjury. Data were compared as phenytoin versus no-phenytoin use, EOS versus no-EOS, and among TBI severity groups.
Results:
During 1 year, 639 TBI patients were included with a mean age of 32 years; of them, 183 received phenytoin as seizure prophylaxis, and 453 received no prophylaxis medication. EOS was documented in 13 (2.0%) patients who received phenytoin, and none had EOS among the nonphenytoin group. The phenytoin group was more likely to have a higher Marshall Score (
Conclusions:
In this study, the prophylactic use of phenytoin in TBI was ineffective in preventing EOS. Large-scale matched studies and well-defined hospital protocols are needed for the proper utility of phenytoin post-TBI.