Antiepileptic for Seizure Prophylaxis in Traumatic Brain Injury Patients

Main Article Content

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.


Download data is not yet available.

Article Details

How to Cite
Malison N. Antiepileptic for Seizure Prophylaxis in Traumatic Brain Injury Patients. BKK Med J [Internet]. 2017Sep.20 [cited 2021Sep.27];13(2):87. Available from:
Reviews Article


1. Panjaisee S, Peunpatom N, Weerasarn K. Clinical Practice Guidelines for Traumatic Brain Injury (1st edition). Bangkok: Thana Press. 2013:1-2.
2. Bureau of Policy and Strategy Ministry of Public Health. Public Health Statistics A.D. 2015. (Accessed Dec 26, 2016 at statistic2558.pdf.)
3. 3. Torbic H, Forni AA, Anger KE, et al. Use of antiepileptics for seizure prophylaxis after traumatic brain injury. Am J Health-Syst Pharm 2013; 70: 759-66.
4. Algattas H, Huang JH. Traumatic brain injury pathophysiology and treatments: early, intermediate, and late phases postinjury. Int J Mol Sci 2014;15:309-41.
5. The Department of Surgical Education, Orlando Regional Medical Center. Seizure prophylaxis in patients with traumatic brain injury. 2012. (Assessed Dec 26, 2016 at http:// 20in%20TBI.pdf.)
6. Brain Trauma Foundation. Guidelines for the management of severe traumatic brain injury 4th edition. 2016:120-9. (Assessed Dec 26, 2016 at 03/12/Guidelines_for_Management_of_Severe_ TBI_4th_Edition.pdf.)
7. Thompson K, Pohlmann-Eden B, Campbell LA, et al. Pharmacological treatments for preventing epilepsy following traumatic head injury. Cochrane Database Syst Rev 2015;8:1- 83.
8. Temkin NR, Dikmen SS, Wilensky AJ, et al. A randomized, double-blind study of Phenytoin for the prevention of post-traumatic seizures. N Engl J Med 1990;323(8):497-502.
9. Frend V, Chetty M. Dosing and therapeutic monitoring of phenytoin in young adults after neurotrauma: are current practices relevant? Clin Neuropharmacol 2007;30:362-9.
10. Zafar SN, Khan AA, Ghauri AA, et al. Phenytoin versus Leviteracetam for seizure prophylaxis after brain injury - a meta-analysis. BMC Neurol 2012;12(30):1-8.
11. Nau KM, Divertie GD, Valentino AK, et al. Safety and efficacy of Levetiracetam for critically ill patients with seizures. Neurocrit Care 2009;11:34-7.
12. Inaba K, Menaker J, Branco BC, et al. A prospective multicenter comparison of Levetiracetam versus Phenytoin for early posttraumatic seizure prophylaxis. J Trauma Acute Care Surg 2013; 74(3):766-73.
13. Gabriel WM, Rowe AS. Long-term comparison of GOS-E scores in patients treated with Phenytoin or Levetiracetam for posttraumatic seizure prophylaxis after traumatic brain injury. Ann Pharmacother 2014;48(11):1440-4.
14. Pieracci FM, Moore EE, BeauchampK, et al. A cost-minimization analysis of Phenytoin versus Levetiracetam for early seizure pharmacoprophylaxis after traumatic brain injury. J Trauma 2012;72: 276-81.
15. Cottn BA, Kao LS, Kozar R, et al. Cost-utility analysis of Levetiracetam and Phenytoin for posttraumatic seizure prophylaxis. J Trauma 2011;71:375-9.
16. Temkin NR, Dikmen SS, Anderson GD, et al. Valproate therapy for prevention of posttraumatic seizures: a randomized trial. J Neurosurg 1999;91(4):593-600.
17. Glötzner FL, Haubitz I, Miltner F, et al. Seizure prevention using carbamazepine following severe brain injuries. Neurochirurgia 1983;26(3):66-79.