Association Between Prophylactic Anti-Seizure Medication and Early Post-Traumatic Seizures: An International Observational Multicenter Study

Abstract

Evidence for the use of prophylactic anti-seizure medication (ASM) in traumatic brain injury (TBI) in reducing the occurrence of early post-traumatic seizure (EPTS) remains equivocal. This study aimed to analyze the prevalence of EPTS in children with TBI, compare clinical characteristics of those with and without EPTS, and explore the association between prophylactic ASM and EPTS. We performed an observational study among 28 pediatric intensive care units in 15 countries from January 2014 to October 2022. The rate of EPTS was compared between individuals prescribed prophylactic ASM and those who were not. Logistic regression was used to examine the association between ASM and EPTS. Among 697 children with TBI, 161 (23.1%) developed EPTS and 280 (40.2%) received prophylactic ASM treatment. Use of prophylactic ASM was associated with a lower likelihood of developing EPTS (27/280 (9.6%) vs. 134/417 (32.1%), p < 0.001). The most frequently used prophylactic ASMs were phenytoin, levetiracetam, and phenobarbital. Age ? 4 years and GCS ? 8 were associated with increased odds of developing EPTS (aOR 2.29, 95% CI 1.54-3.40, p < 0.001 and aOR 1.80, 95% CI 1.18-2.74, p = 0.01). Our data provide evidence supporting the potential protective role of prophylactic ASM against EPTS.