Antiepileptic for Seizure Prophylaxis in Traumatic Brain Injury Patients

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Nattapol Malison, Pharm.D., BCPS, FACP


Antiepileptic drugs should be considered to prevent early posttraumatic seizure(PTS) in patients with moderate or severe traumatic brain injury (TBI). Evidence showsthat antiepileptic drugs do not reduce the risk of late PTS. The recommended first lineantiepileptic drugs for PTS prophylaxis is intravenous phenytoin with a loading doseof 20 mg/kg, followed by a maintenance dose to achieve a serum Phenytoin level at10-20 mg/L. The patient should be closely monitored for responses to the medicationand side effects. Levetiracetam which has equal efficacy may be considered in patientswho cannot tolerate Phenytoin. However, the cost of Levetiracetam may be higher.Valproic acid may be considered in case of limited resources. Carbamazepine can be anoption when all previously mentioned drugs cannot be used. Determining an individualizeddosage regimen and monitoring plan is required during the course of treatment.

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Malison N. Antiepileptic for Seizure Prophylaxis in Traumatic Brain Injury Patients. BKK Med J [Internet]. 2017 Sep. 20 [cited 2024 Apr. 15];13(2):87. Available from:
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