178 Multicenter Prospective Trial of Anti-Epileptics for Early Seizure Prevention in Mild Traumatic Brain Injury with a Positive CT Scan

Abstract

INTRODUCTION: Post-traumatic seizures (PTS) are a major source of disability after traumatic brain injury (TBI). The Brain Trauma Foundation Guidelines recommend prophylactic anti-epileptics (AEDs) for early PTS in severe TBI, but high-quality evidence is lacking in mild or moderate TBI. METHODS: We performed a prospective, multicenter study evaluating consecutive patients who presented to a level 1 trauma center from January 2017 through December 2020. Patients were excluded for previous seizure history, current AED use, or a neurosurgical procedure. Patients were given a 7-day course of prophylactic AEDs on a week-by-week basis and followed with in-person clinic visits, in-hospital evaluation, or a validated phone questionnaire. RESULTS: 490 patients were enrolled, 349 (71.2%) had follow-up, and 139 (39.8%) were given prophylactic AEDs. There was no difference between seizure rates for the prophylactic AED group (0.7%) and those without (2.9%; p = 0.25). Patients who had a PTS were on average older (81.4 years) than patients without a seizure (64.8 years; p = 0.02). Seizure rate increased linearly by age groups: <60 years-old (0%); 60-70 years-old (1.7%); 70-80 years-old (2.3%); and >80 years-old (4.6%). CONCLUSION: Prophylactic AEDs did not provide a benefit for PTS reduction in mild TBI patients with a positive CT head scan. Future studies should be appropriately powered for the small effect size of AEDs in mild TBI and evaluate the effects between age and prophylactic AED use.