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Antiepileptic prophylaxis following severe traumatic brain injury within a military cohort
Mark R Cranley1, M Craner2, E McGilloway3
1Royal Army Medical Corps, Defence Medical Rehabilitation Centre, Epsom, Surrey, UK.
Insights
Antiepileptic prophylaxis after severe traumatic brain injury (TBI) is often not given according to guidelines. This audit found inconsistent use, leading to potential risks for patients, highlighting a need for better implementation of seizure prevention strategies.
Area of Science:
- Neurology
- Trauma Care
- Clinical Audit
Background:
- Traumatic brain injury (TBI) elevates the risk of early and late seizures.
- Antiepileptic prophylaxis can prevent early seizures but does not prevent later post-traumatic epilepsy.
- Prolonged use of these drugs carries risks of side effects and occupational implications.
Purpose of the Study:
- To audit the use of antiepileptic prophylaxis in military patients with severe TBI.
- To assess adherence to recommended 1-week prophylaxis duration.
- To identify variations in drug administration and seizure incidence.
Main Methods:
- Retrospective analysis of electronic and paper records from February 2009 to August 2012.
- Data collection focused on timing and duration of antiepileptic drug use.
- Recording of seizure incidence in patients admitted to the UK Defence Medical Rehabilitation Centre (DMRC).
Main Results:
- 52 patients with severe TBI were included; 48% received prophylaxis in the first week.
- Only 2% received prophylaxis for the recommended 1 week; 42% received it for a mean of 6.2 months.
- Two patients (4%) developed post-traumatic epilepsy and were treated at DMRC.
Conclusions:
- Antiepileptic prophylaxis use in severe TBI patients is highly variable and inconsistent with evidence-based guidelines.
- Current practices expose some patients to increased seizure risk and others to unnecessary drug exposure.
- Improved implementation of antiepileptic prophylaxis protocols is necessary.
Introduction:
Traumatic brain injury increases the risk of both early and late seizures. Antiepileptic prophylaxis reduces early seizures, but their use beyond 1 week does not prevent the development of post-traumatic epilepsy. Furthermore, prolonged prophylaxis exposes patients to side effects of the drugs and has occupational implications. The American Academy of Neurology recommends that antiepileptic prophylaxis should be started for patients with severe traumatic brain injury and discontinued after 1 week. An audit is presented here that investigates the use of prophylaxis in a cohort of military patients admitted to the UK Defence Medical Rehabilitation Centre (DMRC).
Methods:
Data were collected and analysed retrospectively from electronic and paper records between February 2009 and August 2012. The timing and duration of antiepileptic drug use and the incidence of seizures were recorded.
Results:
During the study period, 52 patients with severe traumatic brain injury were admitted to the rehabilitation centre: 25 patients (48%) were commenced on prophylaxis during the first week following injury while 27 (52%) did not receive prophylaxis. Only one patient (2%) received prophylaxis for the recommended period of 1 week, 22 patients (42%) received prophylaxis for longer than 1 week with a mean duration of 6.2 months. Two patients (4%) had post-traumatic epilepsy and started on treatment at DMRC.
Conclusions:
The use of antiepileptic prophylaxis varies widely and is generally inconsistent with evidence-based guidance. This exposes some patients to a higher risk of early seizures and others to unnecessary use of antiepileptics. Better implementation of prophylaxis is required.
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