Pharmacological management of posttraumatic seizures in adults: Current practice patterns in the United Kingdom and the Republic of Ireland

Abstract

Patients who have suffered a traumatic brain injury (TBI) uncertainty remains around posttraumatic seizure prophylaxis and for duration of treatment with antiepileptic drugs (AEDs) for those who developed posttraumatic seizures (PTS). In early 2017, a collaborative group of neurosurgeons, neurologists, neuro-intensive care physicians and rehabilitation medicine physicians was formed in the UK with the aim of examining current practice patterns, gauging the degree of uncertainty, and thus designing relevant future studies. In order to address the first two objectives, we undertook a questionnaire survey of clinicians managing patients with TBI. An online questionnaire survey was developed and piloted. Following approval by the Academic Committee of the Society of British Neurological Surgeons, it was distributed via relevant electronic mailing lists. The online questionnaire was answered by 117 respondents, predominantly neurosurgeons (76%) from 30/32 trauma-receiving hospitals in the United Kingdom and Ireland. Fifty-three percent of respondents do not use seizure prophylaxis and 38% prescribe prophylaxis for 1 week. Seventy percent feel there is uncertainty regarding seizure prophylaxis and 69% would participate in further research to address this question. Sixty-two percent of respondents used levetiracetam for treatment of seizures and 42% continued for a total of 3 months’ post-seizure but 90% were unclear concerning duration of treatment of seizures. The survey results demonstrate the 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 answer these questions and this shows the importance and relevance of these two clinical questions.