Antiseizure medication practices in the adult traumatic brain injury patient population

Abstract

Background: Antiseizure medication (ASM) use in traumatic brain injuries (TBI) reduces the risk of early post-traumatic seizure (PTS). Agent selection and dosing strategies remain inconsistent among trauma centers in the United States.

Objective: The purpose of this study was to identify and characterize the most common PTS prophylaxis regimens among adult trauma centers in brain injured patients throughout the United States.

Methods: A survey assessing PTS prophylaxis practices of trauma centers was created and distributed in March 2023. Data was then evaluated based on practice site demographics and various sub-group analyses including academic vs. non-academic centers, trauma center designation, geographic practice location, and total number of TBI activations annually.

Results: A total of 84 different trauma centers responded of which, 82 (97.6 %) respondents reporting levetiracetam (LEV) as their ASM of choice for PTS prophylaxis. The most reported dosing regimen included an initial dose of 1000 mg (n = 24, 46.2 %) followed by a maintenance dose of 500 mg BID (n = 39, 48.8 %). There were no statistically significant differences in practice between sub-group analyses evaluated.

Conclusion and relevance: This multicenter, survey study, identified variances in practice for PTS prophylaxis for brain injured patients throughout the U.S. Interestingly, the overwhelming majority of trauma centers do not conform to the Brain Trauma Foundation guidelines and utilize LEV as their agent of choice. Further studies should evaluate ideal patient selection for PTS prophylaxis, optimal agent, and dosing schemes within this cohort.

Keywords: Anti-seizure medication; Levetiracetam; Seizure prophylaxis; Traumatic brain injury.