Pharmacological management of post-traumatic seizures in adults: current practice patterns in the UK and the Republic of Ireland

Harry Mee,Fiona Lecky,Timothy Ham,Ari Ercole,Angelos G Kolias,Carole Turner,Peter J Hutchinson,John S Duncan,Jonathan Coles,Diederik Bulters,Mark Manford,Chris Uff,Fahim Anwar,Anthony G Marson,Aswin Chari,Antonio Belli,Catrin Tudur-Smith,Catherine Mcmahon,Mark H Wilson

doi:10.1007/s00701-018-3683-9

Abstract

BackgroundPatient selection for seizure prophylaxis after traumatic brain injury (TBI) and duration of anti-epileptic drug treatment for patients with early post-traumatic seizures (PTS), remain plagued with uncertainty. In early 2017, a collaborative group of neurosurgeons, neurologists, neurointensive care and rehabilitation medicine physicians was formed in the UK with the aim of assessing variability in current practice and gauging the degree of uncertainty to inform the design of future studies. Here we present the results of a survey of clinicians managing patients with TBI in the UK and Ireland.Materials and methodsAn online survey was developed and piloted. Following approval by the Academic Committee of the Society of British Neurological Surgeons, it was distributed via appropriate electronic mailing lists.ResultsOne hundred and seventeen respondents answered the questionnaire, predominantly neurosurgeons (76%) from 30 (of 32) trauma-receiving hospitals in the UK and Ireland. Fifty-three percent of respondents do not routinely use seizure prophylaxis, but 38% prescribe prophylaxis for one week. Sixty percent feel there is uncertainty regarding the use of seizure prophylaxis, and 71% would participate in further research to address this question. Sixty-two percent of respondents use levetiracetam for treatment of seizures during the acute phase, and 42% continued for a total of 3 months. Overall, 90% were uncertain about the duration of treatment for seizures, and 78% would participate in further research to address this question.ConclusionThe survey results demonstrate the variation in practice and uncertainty in both described aspects of management of patients who have suffered a TBI. The majority of respondents would want to participate in future research to help try and address this critical issue, and this shows the importance and relevance of these two clinical questions.

Highlights

Traumatic brain injury (TBI) remains a significant public health problem that can result in physical, cognitive, functional and psychosocial disabilities [7].Post-traumatic seizures (PTS) are well recognised following traumatic brain injury (TBI)
The rationale for seizure prophylaxis with an anti-epileptic drug (AED) during acute hospitalisation is that the incidence of early post-traumatic seizures (PTS) in patients following severe TBI is as high as 14% [12] and prevention of seizures can limit derangements in brain physiology, lower the risk of herniation and death and potentially prevent the development of late PTS
GCS < 9 GCS < 13 I never use seizure prophylaxis secure online survey tool was used to disseminate the questionnaires via the electronic mailing lists of the Society of British Neurological Surgeons (SBNS), British Neurosurgical Trainees Association (BNTA) and included in the Association of British Neurologists newsletter

Summary

Introduction

Traumatic brain injury (TBI) remains a significant public health problem that can result in physical, cognitive, functional and psychosocial disabilities [7].Post-traumatic seizures (PTS) are well recognised following TBI. The rationale for seizure prophylaxis with an anti-epileptic drug (AED) during acute hospitalisation is that the incidence of early PTS in patients following severe TBI is as high as 14% [12] and prevention of seizures can limit derangements in brain physiology, lower the risk of herniation and death and potentially prevent the development of late PTS. AEDs have variable positive, negative or neutral effects in both cognitive and behavioural domains [8]. They are associated with some other side effects including bone density loss, hepatotoxicity and StevensJohnson Syndrome [4]. Patient selection for seizure prophylaxis after traumatic brain injury (TBI) and duration of anti-epileptic drug treatment for patients with early post-traumatic seizures (PTS), remain plagued with uncertainty. Following approval by the Academic Committee of the Society of British Neurological Surgeons, it was distributed via appropriate electronic mailing lists

Methods

Results

Conclusion