From the Guidelines
The recommended duration of antiepileptic treatment following a traumatic head injury is not established, as prevention of post-traumatic seizures with antiepileptic drugs (AEDs) cannot be recommended 1.
Key Considerations
- The use of AEDs for primary prevention of post-traumatic seizures is not suggested due to the lack of significant effect in preventing early or delayed seizures, and the potential for increased side effects 1.
- In cases where risk factors are present, such as chronic subdural hematoma or past history of epilepsy, levetiracetam may be considered as a preferred option due to its higher degree of tolerance compared to phenytoin 1.
- The decision to treat with AEDs should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history.
Treatment Approach
- If AEDs are prescribed, the treatment duration will depend on the individual patient's response to therapy and the presence of ongoing seizure activity.
- In general, medication withdrawal may be considered after a period of seizure freedom, with gradual tapering of the medication over a period of 2-3 months 1.
From the Research
Duration of Antiepileptic Treatment
- The recommended duration of antiepileptic treatment following a traumatic head injury is not clearly defined, with varying practices among clinicians 2.
- A survey of clinicians in the UK and Ireland found that 42% of respondents continued antiepileptic treatment for a total of 3 months, while 90% were uncertain about the duration of treatment 2.
- Another study found that patients with non-severe traumatic brain injury (TBI) were often prescribed levetiracetam for more than 7 days, with 26.1% of patients being discharged with a prescription for levetiracetam despite not having a seizure during hospitalization 3.
- A systematic review and Bayesian network meta-analysis found that phenytoin and levetiracetam were associated with a reduction in the risk of early seizures, but the evidence is very uncertain about the impact of any antiseizure medication on the risk of late seizures or all-cause mortality 4.
- The decision to discontinue antiepileptic drugs in adults with epilepsy should be made after an individualised harm-benefit assessment and consultation with a neurologist, taking into account the risk of seizure recurrence 5.
Factors Influencing Treatment Duration
- The severity of the traumatic brain injury and the presence of early post-traumatic seizures are factors that may influence the duration of antiepileptic treatment 2, 3.
- The type of antiepileptic medication used, such as levetiracetam or phenytoin, may also impact the duration of treatment 3, 4.
- The risk of seizure recurrence after antiepileptic drugs are discontinued depends on the epilepsy syndrome and other risk factors, with approximately 30-50% of patients relapsing 5.