Related Experiment Video
Updated: May 12, 2026
Use of a Wireless Video-EEG System to Monitor Epileptiform Discharges Following Lateral Fluid-Percussion Induced Traumatic Brain Injury
Published on: June 21, 2019
Use of antiepileptics for seizure prophylaxis after traumatic brain injury
Heather Torbic1, Allison A Forni, Kevin E Anger
1Critical Care, Brigham and Women's Hospital, Boston, MA 02115, USA. htorbic@partners.org
Insights
Antiepileptic drugs can prevent seizures after traumatic brain injury (TBI). Phenytoin is recommended, while levetiracetam is a viable alternative with fewer side effects for early posttraumatic seizure (PTS) prophylaxis.
Area of Science:
- Neuroscience
- Pharmacology
- Trauma Care
Background:
- Traumatic brain injury (TBI) affects approximately 275,000 individuals annually.
- 5-7% of TBI patients experience posttraumatic seizures (PTS).
- Current guidelines recommend seizure prophylaxis only within the first week post-TBI.
Purpose of the Study:
- To review antiepileptic drugs for seizure prophylaxis after TBI.
- To evaluate the efficacy and safety of different antiepileptic agents for early PTS prevention.
Main Methods:
- Literature review of antiepileptic drugs used for PTS prophylaxis.
- Analysis of clinical guidelines from the Brain Trauma Foundation and American Academy of Neurology (AAN).
- Comparison of phenytoin, phenobarbital, valproate, carbamazepine, and levetiracetam.
Main Results:
- Phenytoin is the most studied agent and recommended by AAN and Brain Trauma Foundation guidelines.
- Levetiracetam shows comparable efficacy to phenytoin with a better side effect profile.
- Valproate demonstrates similar efficacy but carries a warning for increased mortality.
- Other agents like phenobarbital and carbamazepine lack extensive research for this indication.
Conclusions:
- Antiepileptics are effective for early PTS prophylaxis within the first week after TBI.
- Phenytoin is the guideline-recommended agent for early PTS prophylaxis.
- Levetiracetam is a reasonable alternative due to comparable efficacy and improved tolerability.
Purpose:
Antiepileptics used for seizure prophylaxis after traumatic brain injury (TBI) are reviewed.
Summary:
Of the 275,000 people who are hospitalized with TBI each year, approximately 5-7% experience a posttraumatic seizure (PTS). According to the latest guidelines issued by the Brain Trauma Foundation and the American Academy of Neurology (AAN) for the management of severe TBI, PTS prophylaxis is recommended only during the first seven days after TBI. Of the available antiepileptic drugs, phenytoin has been the most extensively studied for the prophylaxis of PTS. Phenobarbital, valproate, and carbamazepine have not been as extensively researched, and, given their adverse-effect profiles and pharmacodynamic properties, there is no advantage to using these agents over phenytoin. Levetiracetam has demonstrated comparable efficacy to phenytoin for PTS prophylaxis and is associated with fewer adverse effects and monitoring considerations; it may be a reasonable alternative to phenytoin. However, levetiracetam has been associated with an increased seizure tendency. The Brain Trauma Foundation recommends using phenytoin for early PTS prophylaxis. The guidelines also state that valproate has demonstrated similar efficacy to phenytoin but warn that its use may be associated with increased mortality.
Conclusion:
The available literature supports the use of antiepileptics for early PTS prophylaxis during the first week after a TBI. Phenytoin has been extensively studied for this indication and is recommended by the AAN and Brain Trauma Foundation guidelines for early PTS prophylaxis. Levetiracetam has demonstrated comparable efficacy to phenytoin for early PTS prophylaxis and may be a reasonable alternative to consider in this patient population.
Related Concept Videos
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:08Antiepileptic Drugs: Sodium Channel Blockers
Sodium channel blockers modulate ion channels, particularly voltage-gated sodium channels. They block only sodium ion movement.
Among the most commonly prescribed antiepileptic drugs are...
01:20Antiepileptic Drugs: Modulators of Neurotransmitter Release Mediated by SV2A Protein
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
01:18Antiepileptic Drugs: GABAergic Pathway Potentiators
The key GABA pathway potentiators used in epilepsy management are as follows.
Benzodiazepines are a well-known class of drugs used for their...
01:17Antiepileptic Drugs: Calcium Channel Blockers
Calcium channel blockers exert their antiepileptic effects by targeting T-type calcium channels, which are integral to transmitting nerve signals in the central nervous system. These channels allow the passage of calcium ions, which are vital for neuronal communication. By inhibiting T-type calcium channels, calcium channel blockers effectively reduce the release of neurotransmitters and...
01:14Antiepileptic Drugs: Glutamate Antagonists