JAMA Neurol
Is seizure prophylaxis warranted after mild to moderate TBI?
Among patients with mild to moderate traumatic brain injury (TBI), seizure prophylaxis was associated with a small, but significant, reduced risk for early posttraumatic seizures (PTS). the small absolute risk reduction should be weighed against the risks of prescribing antiseizure medications.
- For this systematic review and meta-analysis, investigators reviewed literature for observational studies of adults presenting to trauma centers in high-income countries with mild and moderate TBI. They compared rates of early PTS among patients with seizure prophylaxis vs. those without seizure prophylaxis.
- A total of 64 full articles were reviewed after screening; 8 studies (including 5,637 patients) were included for the mild and moderate TBI analysis, and 5 studies (including 3,803 patients) were included for the mild TBI analysis. The overall rate of early posttraumatic seizures (PTS) was low, ranging from 0% to 4%.
- The absolute risk reduction of seizure prophylaxis for early PTS in mild to moderate TBI (Glasgow Coma Scale [GCS], 9-15) was 0.6% (95% confidence interval [CI], 0.1%-1.2%; P = 0.02). The absolute risk reduction for mild TBI alone was similar at 0.6% (95% CI, 0.01%-1.2%; P = 0.04). The number needed to treat to prevent one seizure was 167.
Source:
Pease M, et al. (2024, April 8). JAMA Neurol. Early Seizure Prophylaxis in Mild and Moderate Traumatic Brain Injury: A Systematic Review and Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/38587858/