Abstract
Background:Seizures account for significant morbidity and mortality early in the course of traumatic brain injury (TBI). Although there is sufficient literature suggesting short-term benefits of antiepileptic drugs (AEDs) in post-TBI patients, there has been no study to suggest a time frame for continuing AEDs in patients who have undergone a decompressive craniectomy for more severe TBI. We examined trends in a level-II trauma center in southern California that may provide guidelines for AED treatment in craniectomy patients.Methods:A retrospective analysis was performed evaluating patients who underwent decompressive craniectomy and those who underwent a standard craniotomy from 2008 to 2012.Results:Out of the 153 patients reviewed, 85 were included in the study with 52 (61%) craniotomy and 33 (39%) craniectomy patients. A total of 78.8% of the craniotomy group used phenytoin (Dilantin), 9.6% used levetiracetam (Keppra), 5.8% used a combination of both, and 3.8% used topiramate (Topamax). The craniectomy group used phenytoin 84.8% and levetiracetam 15.2% of the time without any significant difference between the procedural groups. Craniotomy patients had a 30-day seizure rate of 13.5% compared with 21.2% in craniectomy patients (P = 0.35). Seizure onset averaged on postoperative day 5.86 for the craniotomy group and 8.14 for the craniectomy group. There was no significant difference in the average day of seizure onset between the groups P = 0.642.Conclusion:Our study shows a trend toward increased seizure incidence in craniectomy group, which does not reach significance, but suggests they are at higher risk. Whether this higher risk translates into a benefit on being on AEDs for a longer duration than the current standard of 7 days cannot be concluded as there is no significant difference or trend on the onset date for seizures in either group. Moreover, a prospective study will be necessary to more profoundly evaluate the duration of AED prophylaxis for each one of the stated groups.
Highlights
Traumatic brain injury (TBI) remains one of the major causes of death and disability in the industrialized nations of the world
Our primary objective in this study is to examine the association between seizure rates and seizure prophylaxis in traumatic brain injury (TBI) patients undergoing decompressive craniectomy versus those undergoing a standard craniotomy
Our study shows no significant difference between the craniotomy and craniectomy groups for number of days of prophylaxis, some important considerations need to be made
Summary
Traumatic brain injury (TBI) remains one of the major causes of death and disability in the industrialized nations of the world. In their study of head trauma patients in 1980, Annegers et al found a 30% incidence of seizures less than 7 days following a severe TBI.[1] This study found a marked decrease in seizure rates after 7 days, with a 10% seizure rate 2 years after the TBI. In a randomized double‐blinded study in 1990, Temkins et al further showed that phenytoin given during the early phase (first 7 days) post-TBI showed a significant reduction in seizure rates.[3] this rate reduction did not continue when phenytoin was given beyond 7 days post‐TBI. Seizures account for significant morbidity and mortality early in the course of traumatic brain injury (TBI). We examined trends in a levelII trauma center in southern California that may provide guidelines for AED treatment in craniectomy patients
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