Neurolosurgical Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
Neurology Department, Imperial College Healthcare NHS Trust, London, UK.
J Neurol. 2020 Jun;267(6):1774-1779. doi: 10.1007/s00415-020-09769-5. Epub 2020 Mar 4.
Anti-epileptic drug (AED) prophylaxis in the first-seven days post-traumatic brain injury (TBI) is known to reduce seizure frequency acutely. AED efficacy is equivalent; therefore, choice of AED may rest with their side-effects. We hypothesise that AEDs that impair balance will prolong recovery, shown by a longer hospital stay. We compared length of hospital stay (and reported dizziness) in TBI patients receiving the commonest AEDs used in our TBI patients, Phenytoin (which may cause imbalance), and Levetiracetam (which does not affect balance).
A retrospective observational study was performed on TBI patients admitted to a Major Trauma Unit between October 2013 and June 2018. 100 of 278 patients treated with phenytoin or levetiracetam monotherapy for seizure prophylaxis were included. The inclusion criteria of admission Glasgow Coma Score of 14 or more and length of stay less than 3 weeks minimised confounding variables such as non-ambulant patients. Length of hospital stay and incidence of dizziness were assessed.
The length of hospital stay was longer for patients on Phenytoin versus Levetiracetam, i.e., 10.74 vs. 7.58 days (p = 0.015; unpaired, two-sided t test). Dizziness reported by patients on phenytoin was 24% and levetiracetam was 8% (p = 0.018; Chi-squared test).
In this cohort, using Phenytoin for acute TBI, seizure prophylaxis was associated with longer length of stay and more dizziness compared to Levetiracetam. Given their equivalent AED efficacy in acute TBI seizure prophylaxis, our data suggest that Levetiracetam is preferable to Phenytoin for early seizure prophylaxis in TBI. This requires evaluation in larger, prospective studies.
在创伤性脑损伤（TBI）后前七天内使用抗癫痫药物（AED）预防可显著降低癫痫发作的频率。由于 AED 的疗效相当，因此 AED 的选择可能取决于其副作用。我们假设，会损害平衡的 AED 会延长恢复时间，表现在住院时间更长。我们比较了在我院 TBI 患者中最常用的 AED （可能引起平衡障碍的苯妥英钠和不会影响平衡的左乙拉西坦）治疗的 TBI 患者的住院时间（和报告的头晕）。
对 2013 年 10 月至 2018 年 6 月期间入住大型创伤单位的 TBI 患者进行了回顾性观察研究。对 100 例接受苯妥英钠或左乙拉西坦单药治疗预防癫痫发作的患者进行了研究。纳入标准为入院格拉斯哥昏迷评分（GCS）为 14 分或以上，住院时间少于 3 周，尽量减少非活动患者等混杂因素。评估了住院时间和头晕发生率。
使用苯妥英钠的患者住院时间长于使用左乙拉西坦的患者，分别为 10.74 天和 7.58 天（p = 0.015；未配对，双侧 t 检验）。苯妥英钠组报告头晕的患者为 24%，左乙拉西坦组为 8%（p = 0.018；卡方检验）。
在本队列中，与左乙拉西坦相比，急性 TBI 中使用苯妥英钠预防癫痫发作与住院时间延长和头晕发生率增加相关。鉴于在急性 TBI 癫痫发作预防中，它们具有等效的 AED 疗效，我们的数据表明，在 TBI 中，左乙拉西坦优于苯妥英钠作为早期癫痫发作的预防药物。这需要在更大的前瞻性研究中进行评估。
