What are the implications of seizures following a traumatic fall?

From the Guidelines

If someone experiences seizures after a fall, they should seek immediate medical attention by calling emergency services or going to the nearest emergency room, but antiepileptic drugs should not be used for primary prevention to reduce the incidence of post-traumatic seizures unless there are specific risk factors present, such as chronic subdural hematoma or past history of epilepsy, as suggested by the study 1. Seizures following head trauma can indicate a serious brain injury such as bleeding, bruising, or swelling of the brain. These post-traumatic seizures may occur immediately after the injury or develop days to weeks later.

Key Considerations

• Medical professionals will likely perform imaging studies such as CT scans or MRIs to assess brain damage.
• The decision to prescribe anti-seizure medications like levetiracetam (Keppra) at doses of 500-1000mg twice daily, phenytoin (Dilantin) at 300mg daily, or valproic acid (Depakote) at 500-1000mg daily, depends on the individual's condition and the presence of risk factors, as indicated by the study 1.
• The duration of treatment varies based on seizure recurrence risk, and the study 1 suggests that for patients with a single unprovoked seizure, outpatient studies indicate that initiation of treatment within days to weeks after a seizure prolongs time to a subsequent event, but outcomes at 5 years are no different.

Immediate Care

While awaiting medical help, bystanders should:

• Place the person on their side to prevent choking
• Remove dangerous objects nearby
• Never put anything in the person's mouth Post-traumatic seizures occur because brain injury disrupts normal electrical activity in the brain, creating abnormal electrical discharges that manifest as seizures. Even if the seizure stops quickly, medical evaluation remains essential as it could indicate an underlying condition requiring treatment, as emphasized by the study 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Seizures After a Fall

There are no direct research papers to assist in answering this question. However, some studies provide information on seizures and their treatment:

• Levetiracetam is an antiepileptic drug used to treat various types of seizures, including partial-onset seizures, primary generalized tonic-clonic seizures, and myoclonic seizures of juvenile myoclonic epilepsy 2.
• It has been shown to be effective as adjunctive therapy for refractory partial-onset seizures, primary generalized tonic-clonic seizures, and myoclonic seizures of juvenile myoclonic epilepsy 2.
• Levetiracetam may be used for status epilepticus that is refractory to benzodiazepine therapy, and available evidence suggests that it is as effective as valproic acid or phenytoin for the cessation of status epilepticus in adults 3.
• The efficacy of levetiracetam in controlling seizures has been established in numerous randomized, double-blind, controlled, multicentre trials in patients with epilepsy 4.
• Lamotrigine, levetiracetam, and topiramate are as effective as valproate for treating generalized tonic-clonic, tonic, and clonic seizures 5.

Types of Seizures

Some studies provide information on different types of seizures, including:

• Generalized tonic-clonic seizures, tonic seizures, and clonic seizures 5.
• Myoclonic seizures associated with juvenile myoclonic epilepsy and primary generalized tonic-clonic seizures associated with idiopathic generalized epilepsy 4.
• Partial-onset seizures with or without secondary generalization 4.

Treatment of Seizures

Some studies provide information on the treatment of seizures, including:

• Levetiracetam as adjunctive therapy for refractory partial-onset seizures, primary generalized tonic-clonic seizures, and myoclonic seizures of juvenile myoclonic epilepsy 2.
• Levetiracetam as monotherapy for partial-onset seizures, which was noninferior to carbamazepine controlled release in controlling seizures in patients with newly diagnosed partial-onset seizures 2, 4.
• Valproate, lamotrigine, phenytoin, carbamazepine, topiramate, levetiracetam, and phenobarbital as treatment options for generalized tonic-clonic, tonic, and clonic seizures 5.