[Prophylactic use of antiepileptic drugs for posttraumatic epilepsy]

The link between severe brain trauma and epilepsy in humans is well recognized Posttraumatic epilepsy is reported after 2-5% of closed head injuries but up to 50% or more following penetrating head injury. The control of "early seizures", i.e., those occurring hours or weeks after injury, is mandatory because those acute attacks may add secondary damage to the injured brain. Seizures occuring months or years after injury are called "late seizures". Recurring "late seizures" make up the clinical syndrome of "post-traumatic epilepsy". Prophylaris is the process of guarding against the development of a specific disease by action or treatment that affects pathogenesis. In animal "prophylaxis" by antiepileptic drugs seems efficacious in many experimental models including iron induced epilepsy which is considered a model of post-traumatic epilepsy. In the hunman being "prophylaxis" has been attempted by phenytoin, phenobarbital, carbamazepine and valproate but without any success. During the treatment period the occurrence of scizures is prevented but, after discontinuation of the drug, seizures occur just as in non treated patients. Although prevention of acute seizures that occur following head injury is a practical goal, such treatment is not likely to have a prophylactic effect against late development of epilepsy.