title: Antiepileptic prophylaxis following severe traumatic brain injury within a military cohort.
abstract: BACKGROUND
  Traumatic brain injury increases the risk of both early and late seizures. Antiepileptic prophylaxis reduces early seizures, but their use beyond 1 week does not prevent the development of post-traumatic epilepsy. Furthermore, prolonged prophylaxis exposes patients to side effects of the drugs and has occupational implications. The American Academy of Neurology recommends that antiepileptic prophylaxis should be started for patients with severe traumatic brain injury and discontinued after 1 week. An audit is presented here that investigates the use of prophylaxis in a cohort of military patients admitted to the UK Defence Medical Rehabilitation Centre (DMRC).
  
  
  METHODS
  Data were collected and analysed retrospectively from electronic and paper records between February 2009 and August 2012. The timing and duration of antiepileptic drug use and the incidence of seizures were recorded.
  
  
  RESULTS
  During the study period, 52 patients with severe traumatic brain injury were admitted to the rehabilitation centre: 25 patients (48%) were commenced on prophylaxis during the first week following injury while 27 (52%) did not receive prophylaxis. Only one patient (2%) received prophylaxis for the recommended period of 1 week, 22 patients (42%) received prophylaxis for longer than 1 week with a mean duration of 6.2 months. Two patients (4%) had post-traumatic epilepsy and started on treatment at DMRC.
  
  
  CONCLUSIONS
  The use of antiepileptic prophylaxis varies widely and is generally inconsistent with evidence-based guidance. This exposes some patients to a higher risk of early seizures and others to unnecessary use of antiepileptics. Better implementation of prophylaxis is required.
authors.affiliation: Royal Army Medical Corps, Defence Medical Rehabilitation Centre, Epsom, Surrey, UK.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Cranley
authors.affiliation: Royal Navy Medical Service, Department of Neurology John Radcliffe Hospital, Oxford, UK Department of Neurology, Frimley Park Hospital, UK.
authors.forename: M
authors.initials: M
authors.lastname: Craner
authors.affiliation: Department of Neuro-Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, UK.
authors.forename: E
authors.initials: E
authors.lastname: McGilloway
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy*; D002220:Carbamazepine / Q000627:therapeutic use; D016022:Case-Control Studies; D018890:Chemoprevention; D015331:Cohort Studies; D006801:Humans; D000077287:Levetiracetam; D008889:Military Personnel; D010672:Phenytoin / Q000627:therapeutic use; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000517:prevention & control*; D015599:Trauma Severity Indices; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D002220:Carbamazepine; D000077287:Levetiracetam; D014635:Valproic Acid; D010672:Phenytoin; D010889:Piracetam
keywords: Post traumatic epilepsy; Prophylaxis; Seizure; Traumatic brain injury