SEIZURE PROPHYLAXIS (Guidelines TBI 2016, 4th Ed.)
There was insufficient evidence to support a Level I recommendation for this topic.
LEVEL II A
Prophylactic use of phenytoin or valproate is not recommended for preventing late post traumatic seizures (PTS).
Phenytoin is recommended to decrease the incidence of early PTS (within 7 days of injury), when the overall benefit is felt to outweigh the complications associated with such treatment. However, early PTS have not been associated with worse outcomes.
At the present time there is insufficient evidence to recommend levetiracetam over phenytoin regarding efficacy in preventing early post-traumatic seizures and toxicity.
CHANGES FROM PRIOR EDITION
The recommendations have not changed for this update from the 3rd Edition. Two new Class 2 studies and four new Class 3 studies were added as evidence, but these and the Class 3 studies included from the 3rd Edition did not provide sufficient evidence to inform new recommendations.