Pharmacological Treatments for Preventing Epilepsy Following Traumatic Head Injury

Summary

A Cochrane review [Abstract] 1 included 10 studies with a total of 2326 subjects. All trials included participants with moderate and severe TBI and excluded people with pre-existing epilepsy. Four trials reported on short-term treatments (7 days to one month), 3 reported on mid-term treatments (6 to 12 months), and 3 trials reported on long-term treatments (18 months to 2 years). There were 3 types of interventions: antiepileptic drugs (AED) vs. placebo or standard care, alternative neuroprotective agent vs. placebo or standard care and AED vs. other AED. Treatment with an AED (phenytoin or carbamazepine) decreased the risk of early seizure compared with placebo or standard care (RR 0.42, 95% CI 0.23 to 0.73; 5 trials, n=987). There was no evidence of a difference in the risk of late seizure occurrence between AEDs and placebo or standard care (RR 0.91, 95% CI 0.57 to 1.46; 6 trilas, n=1029). There was no evidence of a significant difference in all-cause mortality between AEDs and placebo or standard care (RR 1.08 95% CI 0.79 to 1.46; 5 trials, n=1065). Only one study (n=499) looked at other potentially neuroprotective agents (magnesium sulfate) compared with placebo. The RRs were: late seizure 1.07 (95% CI 0.53 to 2.17) and all-cause mortality 1.20 (95% CI 0.80 to 1.81).Two studies (n=431) looked at comparison of two AEDs (levetiracetam, valproate) with phenytoin used as the main comparator in each study. The RR for all-cause mortality was 0.53 (95% CI 0.30 to 0.94). There was no evidence of treatment benefit of phenytoin compared with another AED for early seizures (RR 0.66, 95% 0.20 to 2.12) or late seizures (RR 0.77, 95% CI 0.46 to 1.30).Only two studies (n=568) reported adverse events. The RR of any adverse event with AED compared with placebo was 1.65 (95% CI 0.73 to 3.66).