Use of antiseizure medications after traumatic brain injury

Abstract

Background: Post-traumatic seizures and epilepsy are major complications that increase the mortality rate among patients with traumatic brain injury (TBI) and hinder functional recovery. It is important to establish prophylaxis and treatment strategies for high-risk patients. The use of antiseizure medications may not only adversely affect the cognitive function following TBI but also may be associated with a worse rehabilitation outcome.Current Concepts: The level of evidence in the current international guidelines related to the prophylaxis and management of post-traumatic seizure is not robust. Furthermore, the use of antiseizure medications after TBI remains unclear, indicating substantial variations in clinical practice.Discussion and Conclusion: Prophylactic antiseizure medications can reduce the risk of early seizures and partially prevent the secondary injury process of TBI; however, they do not seem to inhibit epileptogenesis. Therefore, if the benefits of preventing early seizures outweigh the potential risks associated with antiseizure medication, it is recommended to use them for a short period of about one week after the injury. Then, it is not recommended to continue using them routinely without considering the individual risk of seizure recurrence and potential adverse effects of long-term use. The treatment duration of anticonvulsant in patients with post-traumatic epilepsy should also be determined based on the individual risk of seizure recurrence, and the decision should take into account the opinions of both the patient and the caregiver, while considering not only the potential benefits but also the risks associated with long-term use.