Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK.
Surgery theme, Cambridge Clinical Trials Unit, Cambridge, UK.
Acta Neurochir (Wien). 2019 Mar;161(3):457-464. doi: 10.1007/s00701-018-3683-9. Epub 2018 Oct 1.
Patient selection for seizure prophylaxis after traumatic brain injury (TBI) and duration of anti-epileptic drug treatment for patients with early post-traumatic seizures (PTS), remain plagued with uncertainty. In early 2017, a collaborative group of neurosurgeons, neurologists, neurointensive care and rehabilitation medicine physicians was formed in the UK with the aim of assessing variability in current practice and gauging the degree of uncertainty to inform the design of future studies. Here we present the results of a survey of clinicians managing patients with TBI in the UK and Ireland.
An online survey was developed and piloted. Following approval by the Academic Committee of the Society of British Neurological Surgeons, it was distributed via appropriate electronic mailing lists.
One hundred and seventeen respondents answered the questionnaire, predominantly neurosurgeons (76%) from 30 (of 32) trauma-receiving hospitals in the UK and Ireland. Fifty-three percent of respondents do not routinely use seizure prophylaxis, but 38% prescribe prophylaxis for one week. Sixty percent feel there is uncertainty regarding the use of seizure prophylaxis, and 71% would participate in further research to address this question. Sixty-two percent of respondents use levetiracetam for treatment of seizures during the acute phase, and 42% continued for a total of 3 months. Overall, 90% were uncertain about the duration of treatment for seizures, and 78% would participate in further research to address this question.
The survey results demonstrate the variation in practice and uncertainty in both described aspects of management of patients who have suffered a TBI. The majority of respondents would want to participate in future research to help try and address this critical issue, and this shows the importance and relevance of these two clinical questions.
颅脑损伤（TBI）后预防性使用抗癫痫药物治疗（AED）的患者选择，以及早期创伤后癫痫发作（PTS）患者的 AED 治疗持续时间，仍然存在不确定性。2017 年初，英国的一组神经外科医生、神经病学家、神经重症监护和康复医学医生组成了一个合作小组，旨在评估当前实践中的变异性，并评估不确定性程度，为未来研究提供信息。在这里，我们报告了一项对英国和爱尔兰 TBI 患者进行管理的临床医生的调查结果。
开发并试点了一项在线调查。在获得英国神经外科学会学术委员会的批准后，通过适当的电子邮件列表进行了分发。
117 名受访者回答了问卷，主要是神经外科医生（76%），来自英国和爱尔兰的 30 家（32 家）创伤接收医院。53%的受访者不常规使用预防性抗癫痫药物，但 38%的人会预防性地使用一周。60%的人认为在使用预防性抗癫痫药物方面存在不确定性，71%的人愿意参与进一步的研究来解决这个问题。62%的受访者在急性期使用左乙拉西坦治疗癫痫发作，42%的人总共持续治疗 3 个月。总的来说，90%的人对癫痫发作的治疗持续时间不确定，78%的人愿意参与进一步的研究来解决这个问题。
调查结果表明，在 TBI 患者的管理中，这两个方面的实践存在差异，而且存在不确定性。大多数受访者希望参与未来的研究，以帮助解决这一关键问题，这表明这两个临床问题的重要性和相关性。
