Department of Neurosurgery, Flinders Medical Centre, Adelaide 5042, Australia.
Department of Neurosurgery, Flinders Medical Centre, Adelaide 5042, Australia.
J Clin Neurosci. 2019 Nov;69:198-205. doi: 10.1016/j.jocn.2019.07.066. Epub 2019 Aug 23.
Current international guidelines for traumatic brain injury (TBI) recommend the use of phenytoin for the prevention of early post traumatic seizures (PTS) when the benefits are thought to outweigh the risks. In practice however, alternative antiepileptic drugs (AEDs) such as levetiracetam and valproate are being used as they are believed to have a more favourable risk profile. This is despite there being insufficient evidence to support their efficacy. The purpose of this study was to identify which AED was prescribed to patients presenting with a TBI at a single institution, and to determine the rate of early PTSs.
This was a retrospective case-note review study done at the Flinders Medical Centre including patients admitted from May 2013 to June 2017. All patients with traumatic intracranial haematomas were included. Patients were excluded if they had seizures prior to presentation to hospital or died within 24 h of injury. The primary outcomes were rate of early PTSs and the type of prophylactic AED prescribed.
During this study period, 610 patients presented with a mild, moderate or severe traumatic brain injury. Overall, 16% of patients were prescribed an AED, with more than 90% of these patients being prescribed levetiracetam. Overall, the rate of early PTSs for patients prescribed AEDs was 2.9% compared with 3.5% for patients not prescribed AEDs (OR 0.83 CI 0.24-2.85 p = 1).
This study showed that levetiracetam was the most commonly prescribed AED. It also demonstrated no statistically significant difference in the rate of early PTSs in patients with TBI, with or without prophylactic AEDs. This is in keeping with other contemporary studies, and therefore the routine administration of prophylactic AEDs may need to be re-examined.
目前，国际创伤性脑损伤（TBI）指南建议使用苯妥英预防创伤后早期癫痫发作（PTS），当获益超过风险时。然而，在实践中，替代抗癫痫药物（AEDs）如左乙拉西坦和丙戊酸钠正在被使用，因为它们被认为具有更有利的风险特征。这是尽管没有足够的证据支持它们的疗效。本研究的目的是确定在单一机构就诊的 TBI 患者使用哪种 AED，并确定早期 PTS 的发生率。
这是一项在弗林德斯医学中心进行的回顾性病历研究，包括 2013 年 5 月至 2017 年 6 月期间入院的患者。所有创伤性颅内血肿患者均包括在内。如果患者在就诊前有癫痫发作或在受伤后 24 小时内死亡，则将其排除在外。主要结局是早期 PTS 的发生率和预防性 AED 的类型。
在这项研究期间，610 例患者患有轻度、中度或重度 TBI。总体而言，16%的患者使用了 AED，其中超过 90%的患者使用了左乙拉西坦。总的来说，服用 AED 的患者早期 PTS 发生率为 2.9%，未服用 AED 的患者为 3.5%（OR 0.83，95%CI 0.24-2.85，p=1）。
本研究表明，左乙拉西坦是最常开的 AED。它还表明，在有或没有预防性 AED 的 TBI 患者中，早期 PTS 的发生率没有统计学上的显著差异。这与其他当代研究一致，因此，预防性 AED 的常规给药可能需要重新审查。
