| Author, Year
Country
Study Design
Sample Size |
Methods |
Outcome |
| Sapina & Ratkovic (2017)
Croatia
Cohort
N=226
|
Population: Post-Traumatic Epilepsy (PTE) Group (n=113): Gender: Males=67, Females=46. Complex Partial Seizures, Control Group (n=113): Gender: Males=20, Females=93.
Treatment: Patients were either administered conventional anti-epileptic drugs (AEDs) (phenytoin, phenobarbital, carbamazepine) or new generation AEDs (topiramate, gabapentin, levetiracetam).
Outcome Measure: Severity of EEG changes, time to remission of seizures. |
1. Both groups significantly reduced the severity of EEG changes with treatment over a five-year period regardless of drug (p<0.05); there were no differences based on type of AED used.
2. In the PTE group, remission was achieved faster with new generation AEDs compared to conventional AEDs (1.4-1.8 vs. 1.7-2.0 months).
3. In both patient groups, the presence of psychiatric comorbidities significantly prolonged time to remission by 3.4 mo (p<0.05). |
| Formisano et al. (2007)
Italy/USA
Pre-Post
N=137
|
Population: TBI; GCS<8. Study 1 (prospective, n=82): Mean Age=27.1yr; Gender: Male=43, Female=12; Time Post Injury=62.1d. Study 2 (retrospective, n=55): Mean Age=25.5yr; Gender: Male=59, Female=23; Time Post Injury=55.9d.
Treatment: Patients were studied retrospectively and prospectively to determine if AEDs were administered and the incidence of late PTE.
Outcome Measure: Occurrence of PTE. |
1. Within study 1, 18% had late PTE; there was no significant difference in the incidence of PTE between non-treated patients and those treated with prophylactic therapy (p=0.29).
2. Within study 2, the occurrence of late PTE was significantly higher in patients treated with an AED (phenobarbital, carbamazepine, phenytoin, or combined therapy) than those not treated (39% vs 0%, p=0.004).
3. Of those treated with AEDs (n=69), 30 showed epileptic abnormalities on their EEGs. |
| Glucocorticoid Medications |
| Watson et al. (2004)
USA
Cohort
N=404
|
Population: Severe TBI; Gender: Male=309, Female=95.
Treatment: Participants who were administered glucocorticoid medications (<1wk post injury; n=125) were compared to those who were not (n=279). 98% of those treated were given dexamethasone. Those in the treatment group were further divided into those administered the drug within 0-1d (n=105) and 2-7d (n=20) post injury. Follow-up continued for 2yr.
Outcome Measure: Occurrence of late seizures (defined based on order of occurrence as first or second late seizures), mortality.
|
1. Compared to the untreated group, those treated within 1d were significantly more likely to develop first late seizures (p=0.04); an increase of 74% in the risk of first late seizures was seen.
2. Receiving glucocorticoids ≥ 2 days after TBI was not associated with first late seizure development.
3. There was no significant association between receiving glucocorticoids within 1d (p=0.28; HR=1.41; CI 95%, 0.75-2.63) or ≥2d (p=0.54; HR0.63; 95% CI, 0.15-2.74) after TBI and second late seizures.
4. No significant differences in the number of first (p=0.10) or second late seizures (p=0.41) were found between the treated and not treated groups.
5. There was no cumulative effect found of glucocorticoid exposure on late seizure development (p=0.63; HR=1.16; 95%CI, 0.63-2.16).
6. No difference was noted in cumulative mortality between groups (p=0.57). |
| Phenobarbital |
| Manaka (1992)
Japan
RCT
PEDro=3
NInitial=244, NFinal=191
|
Population: Head Injury; Severe Group: Mean Age=38.0yr. Mild Group: Mean Age=29.3yr.
Treatment: Patients with severe injuries were divided into two groups: phenobarbital (n=50; 10 – 25 µg/ml) or control (n=76) starting at 4wk post injury for 2yr, tapering off at 3yr. Follow-up continued for 5yr. Participants with mild head injury were in a third group (n=65).
Outcome Measure: Occurrence of seizures. |
*Results of mild head injury group not reported here
1. At follow-up, 12.7% (n=16) of participants with severe head injury developed epileptic attacks; 8 (16%) in the treatment group and 8 (10.5%) controls. |
| Servit & Musil (1981)
Czechoslovakia
Cohort
N=167
|
Population: TBI; Mean Age=30.6yr; Gender: Male=128, Female=39.
Treatment: Participants in the treatment group (n=143) were administered phenytoin (160-240mg/d) and phenobarbital (20-60mg/d). The control group (n=24) was treated with conventional methods for 2yr.
Outcome Measure: Occurrence of late seizures. |
1. Post-traumatic epilepsy occurred in 25% of the control and 2.1% of the treatment group (p<0.001).
|
| Methylphenidate |
| Wroblewski et al. (1992)
USA
Case Series
N=30
|
Population: TBI=25, ABI=5; Mean Age=32y; Mean Time Post Injury=14.1mo.
Treatment: Chart review of individuals with late post-traumatic seizures treated with Methylphenidate. Majority (n=28) also received an anticonvulsant (carbamazepine or valproic acid).
Outcome Measure: Occurrence of seizures. |
1. Four patients had a higher seizure frequency while taking methylphenidate, 13 had a lower frequency of seizures on the medication, and 13 had no change between being on or off the medication.
2. Twenty patients had no seizures while taking methylphenidate.
3. There was a trend toward a lesser frequency of seizures in patients during methylphenidate treatment (p=0.063). |
| Midazolam |
| Wroblewski & Joseph (1992)
USA
Case Series
N=10 |
Population: TBI=8, ABI=1, Other=1; Mean Age=32.9yr; Gender: Male=9, Female=1.
Treatment: Intramuscular midazolam was administered.
Outcome Measure: Cessation of seizures. |
1. All patients experienced seizure cessation within minutes of midazolam administration.
2. The only reported side effect was slight to moderate sedation. |
| Carbamazepine |
| Wroblewski et al. (1989)
USA
Pre-Post
N=27 |
Population: TBI; Mean Age=24yr; Gender: Male=22, Female=5.
Treatment: Patients taking phenytoin or phenobarbital had these medications stopped and replaced with carbamazepine. Patients were on the medication due to previous seizures (n=13) or because they were considered high risk for seizures (n=14).
Outcome Measure: Occurrence of seizures. |
1. For all participants after the medication switch: 10 had a decrease in seizure frequency, 13 had no change, and 4 reported an increase.
For the subgroup of participants with previously documented seizures before the medication switch (n=13): 10 had a decrease in seizure frequency, 1 had no change, and 2 had an increase. |
