662: PROPHYLAXIS FOR THE PREVENTION OF EARLY POSTTRAUMATIC SEIZURES IN TRAUMATIC BRAIN INJURY

Abstract

Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children under 18 years of age. Early posttraumatic seizures (EPTS), seizures occurring within 7 days of initial neurologic injury, are a known complication following TBI. The goal of this study is to discern how efficacious prophylaxis with Levetiracetam or Fosphenytoin is in preventing EPTS in moderate to severe TBI in pediatric patients. Methods: A retrospective observational study at a Level 1 Pediatric Trauma Center was conducted with patients 0-5 years with moderate to severe TBI admitted to the PICU from January 1, 2015 – January 1, 2021. Moderate to severe TBI was defined as Glasgow Coma Scale (GCS) < 13. Patients were identified using ICD-9 and ICD-10 codes. Excluded were patients >5 years old, who presented to the ED with seizures, who received anti-epileptic drug (AED) after a seizure, with non-accidental trauma as the cause of TBI, who did not receive 7 days of AED prophylaxis or died within 7 days of hospital stay. The following points were collected and compared: initial GCS, AED dosage, time to 1st AED dose, occurrence of EPTS, and number of days into hospital stay EPTS occurred. Results: Of 244 patients identified with moderate/severe TBI, 50 patients met inclusion criteria. Subdural hematoma was the most common primary diagnosis (48%). 44 patients (88%) received Levetiracetam. 6 patients (12%) received Fosphenytoin. 5 patients (10%) had EPTS, 95% CI [1.8%, 18.2%]. These 5 patients had received Levetiracetam. The 6 patients that received Fosphenytoin did not have EPTS. Seizures were confirmed with electroencephalography and on average occurred 2.6 days into hospital course. Mean data points of the patients who experienced EPTS: Levetiracetam dose 32.6 mg/kg/day, presenting GCS score 7, and time to administration of 1st AED dose 243 minutes. Mean data points of the patients who did not experience EPTS: Levetiracetam dose 29.3 mg/kg/day, presenting GCS score 9, and time to administration of 1st AED dose 366 minutes. Conclusions: Patients who received Levetiracetam prophylaxis had a higher incidence of EPTS compared to patients who received Fosphenytoin prophylaxis. These patients also had a lower presenting GCS, potentially playing a role in the neuropathophysiology of EPTS.