TOPLINE:
Seizure prophylaxis results in a modest danger decrease for early posttraumatic seizure (PTS) in clients with moderate or moderate distressing brain injury (TBI).
APPROACH:
- Scientist carried out a meta-analysis of 8 research studies consisting of 5637 clients with moderate ( Glasgow Coma Scale [GCS] rating, 13-15) or moderate (GCS score, 9-12) TBI in high-income nations, comparing rates of early PTS with and without seizure prophylaxis.
- Amongst these clients, 1541 got seizure prophylaxis, consisting of levetiracetam phenytoin and valproic acid.
- The main result was the outright danger decrease for early PTS, specified as seizures within 7 days of preliminary injury, in clients with moderate or moderate TBI getting seizure prophylaxis within the very first week post injury.
- The secondary result was the outright danger decrease for moderate TBI alone, evaluated utilizing 5 research studies with 3803 clients.
TAKEAWAY:
- Seizure prophylaxis resulted in a 0.6% outright threat decrease (P =.02) for early PTS in clients with moderate to moderate TBI (GCS score, 9-15).
- The outright danger decrease for moderate TBI alone was 0.6% (P =.04).
- The occurrence of early PTS was low, varying from 0% to 4%.
- An overall of 167 clients needed treatment to avoid an episode of seizure.
IN PRACTICE:
“For clients with threat elements for early PTS as explained formerly, dealing with clinicians ought to think about setting up seizure prophylaxis,” the authors composed. “Practitioners must weigh low frequency of early PTS and low threat decrease versus threats of antiseizure medication, consisting of unsuitable long-lasting extension,” they even more included.
SOURCE:
This research study was led by Matthew Pease, MD, Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, and was released online on April 8, 2024, in JAMA Neurology
CONSTRAINTS:
The addition of 6 retrospective research studies on seizures and just one potential research study might have presented predisposition. The transfer of clients with serious injuries to level-1 centers may have restricted generalizability. The lack of randomized medical trials might have postured obstacles for properly powered trials. Customized choices by specialists, such as recommending seizure prophylaxis just to clients with more extreme injuries, might have presented predisposition and weakened the efficiency of the prophylaxis.
DISCLOSURES:
3 authors reported getting consulting charges from medical innovation business like Zimmer Biomet, NeuroOne Medical, and Neuroelectrics. One author reported getting grants from the National Institutes of Health or National Institute of Neurological Disorders and Strokeoutside the sent work. No other disclosures were reported.