Seizures and the Role of Anticonvulsants After Traumatic Brain Injury

Zimmermann, Lara; Vespa, Paul

doi:10.1016/j.nec.2016.06.001

Cited by 33 publications

(36 citation statements)

References 51 publications

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“…Posttraumatic seizures may be classified as immediate seizures (occurring less than 24 hours after injury), early seizures (occurring 24 hours to 7 days after injury), and late seizures (occurring more than 7 days after injury). Late seizures often lead to lifelong epilepsy . Antiepileptic medication reduces immediate and early seizures but not late seizures.…”

Section: Posttraumatic Seizuresmentioning

confidence: 99%

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Management of moderate and severe traumatic brain injury

2019

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Traumatic brain injury (TBI) is a common disorder with high morbidity and mortality, accounting for one in every three deaths due to injury. Older adults are especially vulnerable. They have the highest rates of TBI‐related hospitalization and death. There are about 2.5 to 6.5 million US citizens living with TBI‐related disabilities. The cost of care is very high. Aside from prevention, little can be done for the initial primary injury of neurotrauma. The tissue damage incurred directly from the inciting event, for example, a blow to the head or bullet penetration, is largely complete by the time medical care can be instituted. However, this event will give rise to secondary injury, which consists of a cascade of changes on a cellular and molecular level, including cellular swelling, loss of membrane gradients, influx of immune and inflammatory mediators, excitotoxic transmitter release, and changes in calcium dynamics. Clinicians can intercede with interventions to improve outcome in the mitigating secondary injury. The fundamental concepts in critical care management of moderate and severe TBI focus on alleviating intracranial pressure and avoiding hypotension and hypoxia. In addition to these important considerations, mechanical ventilation, appropriate transfusion of blood products, management of paroxysmal sympathetic hyperactivity, using nutrition as a therapy, and, of course, venous thromboembolism and seizure prevention are all essential in the management of moderate to severe TBI patients. These concepts will be reviewed using the recent 2016 Brain Trauma Foundation Guidelines to discuss best practices and identify future research priorities.

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Section: Posttraumatic Seizuresmentioning

confidence: 99%

“…Late seizures often lead to lifelong epilepsy. 104 Antiepileptic medication reduces immediate and early seizures but not late seizures. Thus, the 2016 BTF CPG recommend that phenytoin be prescribed for the first 7 days after injury to reduce the incidence of early PTS.…”

Section: Posttraumatic Seizuresmentioning

confidence: 99%

Management of moderate and severe traumatic brain injury

2019

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“…Additionally, patients with persistently reduced consciousness considered disproportionate to the extent of neurological injury, 15-20% will display signs of non-convulsive seizures on continuous electroencephalography. 52 Anticonvulsants are typically continued throughout the admission for patients who have sustained a seizure, and weaned gradually after discharge under neurological supervision.…”

Section: Treatmentmentioning

confidence: 99%

Head injury in the elderly – an overview for the physician

et al. 2019

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Head injury is a common cause for hospital admission and additionally 250,000 UK inpatients fall during hospital admissions annually. Head injury most commonly occurs as a result of falls from standing height in older adults. Older adults are frequently frail and multi-morbid; many have indications for anticoagulation and antiplatelet agents. The haemorrhagic complications of head injury occur in up to 16% of anticoagulated patients sustaining a head injury. These patients suffer adverse outcomes from surgery as a result of medical complications. Although geriatric trauma models are evolving to meet the demand of an ageing trauma population, medical support to trauma services is commonly delivered by general physicians, many of whom lack experience and training in this fi eld. Determining the role of surgery and interrupted anticoagulation requires careful personalised risk assessment. Appreciation of the opposing risks can be challenging; it requires an understanding of the evidence base in both surgery and medicine to rationalise decision making and inform communication. This article aims to provide an overview for the physician with clinical responsibility for patients who have sustained head injury.

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“…Approximately one in five patients with severe TBI will suffer an early seizure (<7 days from injury). 94,95 High-quality evidence supports the use of antiepileptics for prophylaxis of early, but not late (>7 days), seizures, originally examining phenytoin, 96 a recommendation which exists to today as per the BTF. 34 Many institutions have transitioned to levetiracetam, which does not require serum monitoring, which is less expensive, and has more favorable side effects and drug interactions, after several studies demonstrating that it is as effective as phenytoin in preventing early seizures.…”

Section: Seizure Prophylaxismentioning

confidence: 99%

Management and Challenges of Severe Traumatic Brain Injury

Rakhit

Nordness

Lombardo

et al. 2020

Semin Respir Crit Care Med

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Traumatic brain injury (TBI) is the leading cause of death and disability in trauma patients, and can be classified into mild, moderate, and severe by the Glasgow coma scale (GCS). Prehospital, initial emergency department, and subsequent intensive care unit (ICU) management of severe TBI should focus on avoiding secondary brain injury from hypotension and hypoxia, with appropriate reversal of anticoagulation and surgical evacuation of mass lesions as indicated. Utilizing principles based on the Monro–Kellie doctrine and cerebral perfusion pressure (CPP), a surrogate for cerebral blood flow (CBF) should be maintained by optimizing mean arterial pressure (MAP), through fluids and vasopressors, and/or decreasing intracranial pressure (ICP), through bedside maneuvers, sedation, hyperosmolar therapy, cerebrospinal fluid (CSF) drainage, and, in refractory cases, barbiturate coma or decompressive craniectomy (DC). While controversial, direct ICP monitoring, in conjunction with clinical examination and imaging as indicated, should help guide severe TBI therapy, although new modalities, such as brain tissue oxygen (PbtO2) monitoring, show great promise in providing strategies to optimize CBF. Optimization of the acute care of severe TBI should include recognition and treatment of paroxysmal sympathetic hyperactivity (PSH), early seizure prophylaxis, venous thromboembolism (VTE) prophylaxis, and nutrition optimization. Despite this, severe TBI remains a devastating injury and palliative care principles should be applied early. To better affect the challenging long-term outcomes of severe TBI, more and continued high quality research is required.

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Seizures and the Role of Anticonvulsants After Traumatic Brain Injury

Cited by 33 publications

References 51 publications

Management of moderate and severe traumatic brain injury

Management of moderate and severe traumatic brain injury

Head injury in the elderly – an overview for the physician

Management and Challenges of Severe Traumatic Brain Injury

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