McNamara Caitlin R, Menchaca Cesar I, Abel Taylor J, Horvat Christopher M, Berger Rachel P, Fink Ericka L, Kochanek Patrick M, Simon Dennis W
Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 2nd Floor, Pittsburgh, PA, 15224-1334, USA.
Neurocrit Care. 2025 Apr;42(2):502-511. doi: 10.1007/s12028-024-02093-0. Epub 2024 Sep 5.
Seizures occur frequently in pediatric patients with traumatic brain injury (TBI), particularly abusive head trauma (AHT). There are limited data on the effectiveness of fosphenytoin and levetiracetam to prevent posttraumatic seizures.
We performed a retrospective single center cohort study of children < 3 years old admitted with mild [Glasgow Coma Scale (GCS) score 13-15], moderate (GCS 9-12), and severe (GCS 3-8) TBI at a level I trauma center from 2011 to 2021. Antiseizure medications were used at the discretion of the treating physicians. Nonparametric tests were used to compare antiseizure medication prophylaxis and TBI etiology.
A total of 717 patients (263 with AHT, 454 with accidental TBI) were included, of whom 135 (19%) received fosphenytoin, 152 (21%) received levetiracetam, and 430 (60%) did not receive any seizure prophylaxis. Over the study period, the use of fosphenytoin prophylaxis decreased (R = 0.67, p = 0.004), whereas the use of levetiracetam increased (R = 0.51, p = 0.008). Additionally, the occurrence of early posttraumatic seizures decreased (R = 0.58, p = 0.006). Children with AHT were more likely to receive any seizure prophylaxis than those with accidental TBI (52% vs. 27%; p < 0.001) and were more likely to have ≥ 1 seizure during hospitalization (22% vs. 4%; p < 0.001). Among children who received seizure prophylaxis, those who received fosphenytoin had a higher occurrence of seizures than those who received levetiracetam (33% vs.18%; p = 0.004). After controlling for age, admission year, TBI mechanism, and severity of injury, we observed no differences in seizure occurrence between groups.
In children < 3 years old with TBI, no differences were observed in occurrence of seizures between patients who received fosphenytoin and patients who received levetiracetam prophylaxis after controlling for patient factors including severity of injury. Levetiracetam may be an equally effective alternative to fosphenytoin for seizure prophylaxis for early posttraumatic seizure prevention in this age group.
癫痫发作在创伤性脑损伤（TBI）的儿科患者中频繁发生，尤其是虐待性头部创伤（AHT）。关于磷苯妥英和左乙拉西坦预防创伤后癫痫的有效性的数据有限。
我们对2011年至2021年在一级创伤中心收治的年龄小于3岁的轻度（格拉斯哥昏迷量表[GCS]评分13 - 15）、中度（GCS 9 - 12）和重度（GCS 3 - 8）TBI患儿进行了一项回顾性单中心队列研究。抗癫痫药物由治疗医生酌情使用。采用非参数检验比较抗癫痫药物预防情况和TBI病因。
共纳入717例患者（263例AHT，454例意外TBI），其中135例（19%）接受了磷苯妥英治疗，152例（21%）接受了左乙拉西坦治疗，430例（60%）未接受任何癫痫预防治疗。在研究期间，磷苯妥英预防治疗的使用减少（R = 0.67，p = 0.004），而左乙拉西坦的使用增加（R = 0.51，p = 0.008）。此外，创伤后早期癫痫发作的发生率下降（R = 0.58，p = 0.006）。与意外TBI患儿相比，AHT患儿更有可能接受任何癫痫预防治疗（52%对27%；p < 0.001），并且在住院期间更有可能发生≥1次癫痫发作（22%对4%；p < 0.001）。在接受癫痫预防治疗的儿童中，接受磷苯妥英治疗的患儿癫痫发作发生率高于接受左乙拉西坦治疗的患儿（33%对18%；p = 0.004）。在控制年龄、入院年份、TBI机制和损伤严重程度后，我们观察到各组之间癫痫发作发生率无差异。
在年龄小于3岁的TBI患儿中，在控制包括损伤严重程度等患者因素后，接受磷苯妥英治疗的患者和接受左乙拉西坦预防治疗的患者之间癫痫发作发生率无差异。对于该年龄组创伤后早期癫痫预防，左乙拉西坦可能是磷苯妥英预防癫痫发作的同样有效的替代药物。
