Use of Anti-epileptic Drugs for Post Traumatic Seizure: A Global Survey

Abstract

Background Post traumatic seizures (PTS) and post traumatic epilepsy (PTE) are potential consequences of traumatic brain injury (TBI). There is no consensus regarding its management among treating doctors. Purpose We have undertaken a global survey to assess the variability of management practices of PTS and PTE and highlight the pressing need to formulate uniform practice guidelines. Methods A questionnaire consisting of sixteen questions were developed with the help of Google survey and sent through e-mail, or social media platforms like WhatsApp, Facebook messenger or Telegram, to practicing Neurologists and Neurosurgeons round the world. Results There were a total of 220 responses. Majority of our responders (n = 202; 91.8%) would start an anti-epileptic (AED) prophylaxis to prevent PTS; 18 people (8.18%) told that they would not start AED prophylaxis for TBI. Phenytoin (n = 98; 48.5%) followed by Levetiracetam (n = 78; 38.6%) was the preferred drug, although the latter was significantly preferred by high and upper middle-income countries ( p<.001). Majority (n = 99; 49%) would not use it beyond two weeks. Most clinicians would manage PTE with a single drug (n = 160; 72.7%) either Phenytoin (n = 69; 31.3%) or levetiracetam (n = 67; 30.4%). Most of them (n = 174; 86%) would treat for less than one year. Conclusions Practices in the management of PTS and PTE vary widely among clinicians. Our study point towards the need for the development of a more robust and comprehensive practice guidelines for the management of the same.