title: More harm than good: antiseizure prophylaxis after traumatic brain injury does not decrease seizure rates but may inhibit functional recovery.
abstract: BACKGROUND
  The purposes of this study were to examine the current Brain Trauma Foundation recommendation for antiseizure prophylaxis with phenytoin during the first 7 days after traumatic brain injury (TBI) in preventing seizures and to determine if this medication affects functional recovery at discharge.
  
  
  METHODS
  The records of adult (age ≥ 18 years) patients with blunt severe TBI who remained in the hospital at least 7 days after injury were retrospectively reviewed from January 2008 to January 2010. Clinical seizure rates during the first 7 days after injury and functional outcome at discharge were compared for the two groups based on antiseizure prophylaxis, no prophylaxis (NP) versus phenytoin prophylaxis (PP). Statistical analysis was performed using χ2.
  
  
  RESULTS
  A total of 93 adult patients who met the previously mentioned criteria were identified (43 [46%] NP group vs. 50 [54%] PP group). The two groups were well matched. Contrary to expectation, more seizures occurred in the PP group as compared with the NP group; however, this did not reach significance (PP vs. NP, 2 [4%] vs. 1 [2.3%], p = 1). There was no significant difference in the two groups (PP vs. NP) as far as disposition are concerned, mortality caused by head injury (4 [8%] vs. 3 [7%], p = 1), discharge home (16 [32%] vs. 17 [40%], p = 0.7), and discharge to rehabilitation (30 [60%] vs. 23 [53%], p = 0.9). However, with PP, there was a significantly longer hospital stay (PP vs. NP, 36 vs. 25 days, p = 0.04) and significantly worse functional outcome at discharge based on Glasgow Outcome Scale (GOS) score (PP vs. NP, 2.9 vs. 3.4, p < 0.01) and modified Rankin Scale score (2.3 ± 1.7 vs. 3.1 ± 1.5, p = 0.02).
  
  
  CONCLUSIONS
  PP may not decrease early posttraumatic seizure and may suppress functional outcome after blunt TBI. These results need to be verified with randomized studies before recommending changes in clinical practice and do not apply to penetrating trauma.
  
  
  METHODS
  Therapeutic study, level IV; epidemiologic study, level III.
authors.affiliation: From the Division of Acute Care Surgery (I.S.B., J.P., A.K., E.F.), Division of Pharmacy (D.J.), and Division of Pediatrics (J.J.T.), University of Florida College of Medicine (D.J., J.P., E.F.), Jacksonville, Florida..
authors.forename: Indermeet S
authors.initials: IS
authors.lastname: Bhullar
authors.forename: Donald
authors.initials: D
authors.lastname: Johnson
authors.forename: Julia P
authors.initials: JP
authors.lastname: Paul
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerwin
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Tepas
authors.forename: Eric R
authors.initials: ER
authors.lastname: Frykberg
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications* / Q000188:drug therapy; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D010672:Phenytoin / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin