Seizure posttraumatic

Acute head injuries A study evaluating the effect of IV valproate in the prevention of posttraumatic seizures in patients with acute head injuries found a higher incidence of death in valproate treatment groups compared with the IV phenytoin treatment group. Until further information is available, it seems prudent not to use valproate sodium injection in patients with acute head trauma for the prophylaxis of posttraumatic seizures. 

Use of phenytoin for the prophylaxis of posttraumatic seizures usually should be discontinued after 7 days if no seizures are observed. 

Haltiner AM, Newell DW, Temkin NR, et al. Side effects and mortality associated with use of phenytoin for early posttraumatic seizure prophylaxis. J Neurosurg 1999 91 588-592. 

Temkin NR, Dikmen SS, Anderson GD, et al. Valproate therapy for prevention of posttraumatic seizures A randomized trial. J Neurosurg 1999 91 593-600. 

Early use of antiepileptics may improve outcome. Posttraumatic seizures (PTS) may develop in up to 20% of patients with TBI (Temkin et al., 1990). Seizures increase cerebral blood flow and metabolic demand, which increases ICP and aggravates secondary brain injury (Vespa et al., 2007). Thus, early antiepileptic therapy is recommended, which can reduce the rate of early PTS, but does not prevent later development of PTS (Temkin, 2001). 

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