Deans' stroke musings: Early Seizure Prophylaxis in Mild and Moderate Traumatic Brain Injury

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, April 9, 2024

Early Seizure Prophylaxis in Mild and Moderate Traumatic Brain Injury

With decent stroke leadership we would have research to see if this can prevent seizures post stroke. But there is NO STROKE LEADERSHIP ANYWHERE!

With your chance of epileptic seizures post stroke, your doctor is responsible to know EXACTLY how to prevent them.

Approximately 5 percent of people will have a seizure within a few weeks after having a stroke, according to the National Stroke Association.

Be careful out there. Some research points to a 10-40% epilepsy incidence rate for survivors. What is your doctor doing to ensure you don't get epilepsy?

Early Seizure Prophylaxis in Mild and Moderate Traumatic Brain Injury

A Systematic Review and Meta-Analysis

Matthew Pease, MD¹; Adi Mittal, BS²; Sara Merkaj, BS³; et al David O. Okonkwo, MD, PhD⁴; Jorge A. Gonzalez-Martinez, MD, PhD⁴; Jonathan Elmer, MD, MS^5,6,7; Wen-Shyong Liou, MD⁸; Valeria Pingue, MD⁹; Flora M. Hammond, MD¹⁰; Sergiu Abramovici, MD¹¹; James Castellano, MD, PhD⁵; Niravkumar Barot, MD¹²

Author Affiliations

JAMA Neurol. Published online April 8, 2024. doi:10.1001/jamaneurol.2024.0689

Key Points

Question Is seizure prophylaxis associated with reduced risk for early posttraumatic seizures, defined as seizures within 7 days of injury, for patients with mild or moderate traumatic brain injury?

Findings In this systematic review and meta-analysis including 8 studies, the absolute risk reduction of seizure prophylaxis for early posttraumatic seizures was 0.6% in mild and moderate traumatic brain injury. The overall rate of early posttraumatic seizures was low, ranging from 0% to 4%.

Meaning Study results suggest that seizure prophylaxis was associated with a small, albeit significant, reduced risk for early posttraumatic seizures for mild to moderate traumatic brain injury; the small absolute risk reduction should be weighed against the risks of prescribing antiseizure medications.

Abstract

Importance Guidelines recommend seizure prophylaxis for early posttraumatic seizures (PTS) after severe traumatic brain injury (TBI). Use of antiseizure medications for early seizure prophylaxis after mild or moderate TBI remains controversial.

Objective To determine the association between seizure prophylaxis and risk reduction for early PTS in mild and moderate TBI.

Data Sources PubMed, Google Scholar, and Web of Science (January 1, 1991, to April 18, 2023) were systematically searched.

Study Selection Observational studies of adult patients presenting to trauma centers in high-income countries with mild (Glasgow Coma Scale [GCS], 13-15) and moderate (GCS, 9-12) TBI comparing rates of early PTS among patients with seizure prophylaxis with those without seizure prophylaxis.

Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) reporting guidelines were used. Two authors independently reviewed all titles and abstracts, and 3 authors reviewed final studies for inclusion. A meta-analysis was performed using a random-effects model with absolute risk reduction.

Main Outcome Measures The main outcome was absolute risk reduction of early PTS, defined as seizures within 7 days of initial injury, in patients with mild or moderate TBI receiving seizure prophylaxis in the first week after injury. A secondary analysis was performed in patients with only mild TBI.

Results A total of 64 full articles were reviewed after screening; 8 studies (including 5637 patients) were included for the mild and moderate TBI analysis, and 5 studies (including 3803 patients) were included for the mild TBI analysis. The absolute risk reduction of seizure prophylaxis for early PTS in mild to moderate TBI (GCS, 9-15) was 0.6% (95% CI, 0.1%-1.2%; P = .02). The absolute risk reduction for mild TBI alone was similar 0.6% (95% CI, 0.01%-1.2%; P = .04). The number needed to treat to prevent 1 seizure was 167 patients.

Conclusion and Relevance Seizure prophylaxis after mild and moderate TBI was associated with a small but statistically significant reduced risk of early posttraumatic seizures after mild and moderate TBI. The small absolute risk reduction and low prevalence of early seizures should be weighed against potential acute risks of antiseizure medications as well as the risk of inappropriate continuation beyond 7 days.