Early seizure prophylaxis with antiepileptics in TBI has only modest effects

  • Wat R & al.
  • World Neurosurg
  • 19 Nov 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For early seizure prophylaxis in traumatic brain injury (TBI), antiepileptic drugs (AEDs) have at best modest effects vs placebo or no treatment at all, according to this meta-analysis and systematic review.
  • Randomized controlled trials (RCTs) found no effect, while observational studies suggest some effect.

Why this matters

  • The authors say that clinicians should decide on a case-by-case basis and that results support the caution in the current recommendations.

Key results

  • RCTs evaluated phenytoin.
  • Pooled relative risk (RR) of the 3 RCTs (2 in adults, all 3 on severe TBI, phenytoin): 
    • 0.50 (95% CI, 0.24-1.03; I2=59.5%).
  • 1 RCT involving children showed tendency toward increased seizure risk (RR, 1.22; 95% CI, 0.14-10.9).
  • Pooled RR across 6 observational studies (all retrospective cohort; phenytoin, levetiracetam, or valproate evaluated): 0.43 (95% CI, 0.26-0.71; I2=0%).
  • Observational studies examined by drug: no difference.
  • No publication bias found for observational studies.

Study design

  • Meta-analysis and systematic review of 3 RCTs (n=750) and 6 observational studies (n=3362).
  • Funding: None.

Limitations

  • Those of the original studies; search confined to English-only publications.

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