- 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.
- 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.
- Meta-analysis and systematic review of 3 RCTs (n=750) and 6 observational studies (n=3362).
- Funding: None.
- Those of the original studies; search confined to English-only publications.