From the Guidelines
The best management for an 11-year-old child with post-traumatic seizures occurring 2 weeks after head trauma involves immediate medical evaluation and initiation of antiepileptic medication, with CT head without IV contrast or MRI head without IV contrast being usually appropriate for the initial imaging, as stated in the study by 1 and 1. The child should undergo urgent neuroimaging to assess for structural abnormalities like contusions, hematomas, or evolving injury that might be causing the seizures.
- Levetiracetam (Keppra) is typically the first-line treatment, usually started at 10-20 mg/kg/day divided twice daily, with gradual titration up to 60 mg/kg/day if needed.
- Alternatively, oxcarbazepine or carbamazepine may be considered.
- An electroencephalogram (EEG) is essential to characterize the seizure type and identify epileptiform activity.
- Regular follow-up with a pediatric neurologist is necessary to monitor seizure control, medication side effects, and developmental progress.
- Parents should be educated about seizure first aid, medication administration, and recognizing warning signs requiring emergency care.
- Post-traumatic seizures occurring in this timeframe (late seizures) carry a higher risk of developing into epilepsy compared to immediate post-injury seizures, which is why anticonvulsant therapy is typically continued for at least 6-12 months, with potential tapering based on seizure control and EEG findings, as mentioned in the study by 1. It's also important to note that prevention of post-traumatic seizures with AEDs cannot be recommended, as stated in the study by 1, but it can be considered in case of risk factors, e.g. chronic subdural haematoma, or past history of epilepsy, and levetiracetam should be preferred to phenytoin due to a higher degree of tolerance. The American College of Radiology (ACR) Appropriateness Criteria for seizures and epilepsy, as mentioned in the study by 1 and 1, recommend MRI as the imaging study of choice when indicated, but CT may be quicker in an emergent setting.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Seizures after Head Trauma
The management of an 11-year-old child with seizures after a history of head trauma 2 weeks ago can be considered based on the available evidence.
- Seizure Prophylaxis: Studies have compared the efficacy of levetiracetam and phenytoin in preventing post-traumatic seizures 2, 3, 4.
- Levetiracetam vs Phenytoin: While some studies suggest that levetiracetam may have a better side-effect profile, the evidence regarding its efficacy in preventing seizures is mixed 2, 3, 4.
- Neuroprotective Effects: Levetiracetam has been shown to have neuroprotective effects in models of intracranial hemorrhage injury 5.
- Seizure Prevention in Brain Tumor Patients: Levetiracetam has been found to be effective in reducing seizures in patients with brain tumors 6.
Best Management Option
Based on the available evidence, the best management option for the child would be to follow up with serial Brain CT scans to monitor for any potential complications, and consider the use of levetiracetam or phenytoin for seizure prophylaxis, depending on the specific clinical circumstances and the child's medical history.
- Follow-up with Serial Brain CT: This option allows for close monitoring of the child's condition and can help identify any potential complications early on.
- Levetiracetam or Phenytoin: The choice between levetiracetam and phenytoin would depend on the child's specific needs and medical history, as well as the potential side effects and benefits of each medication.
It is essential to consult with a healthcare professional to determine the best course of treatment for the child.