Pease Matthew, Zaher Mazen, Lopez Alejandro J, Yu Siyuan, Egodage Tanya, Semroc Suzan, Arefan Dooman, Jankowitz Brian
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
Department of Neurosurgery, Medical School, Cooper University, Camden, United States.
Surg Neurol Int. 2022 Jun 10;13:241. doi: 10.25259/SNI_38_2022. eCollection 2022.
Posttraumatic seizures (PTSs) are a major source of disability after traumatic brain injury (TBI). The Brain Trauma Foundation Guidelines recommend prophylactic anti-epileptics (AEDs) for early PTS in severe TBI, but high-quality evidence is lacking in mild TBI.
To determine the benefit of administering prophylactic AEDs, we performed a prospective and multicenter study evaluating consecutive patients who presented to a Level 1 trauma center from January 2017 to December 2020. We included all patients with mild TBI defined as Glasgow Coma Scale (GCS) 13-15 and a positive head computed tomography (CT). Patients were excluded for previous seizure history, current AED use, or a neurosurgical procedure. Patients were given a prophylactic 7-day course of AEDs on a week-on versus week-off basis and followed with in-person clinic visits, in-hospital evaluation, or a validated phone questionnaire.
Four hundred and ninety patients were enrolled, 349 (71.2%) had follow-up, and 139 (39.8%) were given prophylactic AEDs. There was no difference between seizure rates for the prophylactic AED group (0.7%) and those without (2.9%; = 0.25). Patients who had a PTS were on average older (81.4 years) than patients without a seizure (64.8 years; = 0.02). Seizure rate increased linearly by age groups: <60 years old (0%); 60-70 years old (1.7%); 70-80 years old (2.3%); and >80 years old (4.6%).
Prophylactic AEDs did not provide a benefit for PTS reduction in mild TBI patients with a positive CT head scan.
创伤后癫痫（PTS）是创伤性脑损伤（TBI）后致残的主要原因。脑创伤基金会指南建议对重度TBI的早期PTS使用预防性抗癫痫药物（AED），但轻度TBI缺乏高质量证据。
为确定使用预防性AED的益处，我们进行了一项前瞻性多中心研究，评估2017年1月至2020年12月在一级创伤中心就诊的连续患者。我们纳入了所有轻度TBI患者，定义为格拉斯哥昏迷量表（GCS）评分为13 - 15分且头部计算机断层扫描（CT）阳性。有癫痫病史、正在使用AED或接受过神经外科手术的患者被排除。患者按一周用药一周停药的方式接受为期7天的预防性AED疗程，并通过门诊复诊、住院评估或经过验证的电话问卷进行随访。
共纳入490例患者，349例（71.2%）进行了随访，139例（39.8%）接受了预防性AED治疗。预防性AED组的癫痫发作率（0.7%）与未接受预防性AED治疗组（2.9%）之间无差异（P = 0.25）。发生PTS的患者平均年龄（81.4岁）高于未发生癫痫的患者（64.8岁；P = 0.02）。癫痫发作率按年龄组呈线性增加：<60岁（0%）；60 - 70岁（1.7%）；70 - 80岁（2.3%）；>80岁（4.6%）。
对于头部CT扫描阳性的轻度TBI患者，预防性AED并不能降低PTS的发生率。
