Antiepileptic drugs should be considered to prevent early posttraumatic seizure (PTS) in patients with moderate or severe traumatic brain injury (TBI). Evidence shows that antiepileptic drugs do not reduce the risk of late PTS. The recommended first line antiepileptic drugs for PTS prophylaxis is intravenous phenytoin with a loading dose of 20 mg/kg, followed by a maintenance dose to achieve a serum Phenytoin level at 10-20 mg/L. The patient should be closely monitored for responses to the medication and side effects. Levetiracetam which has equal efficacy may be considered in patients who cannot tolerate Phenytoin. However, the cost of Levetiracetam may be higher. Valproic acid may be considered in case of limited resources. Carbamazepine can be an option when all previously mentioned drugs cannot be used. Determining an individualized dosage regimen and monitoring plan is required during the course of treatment.
antiepileptic, seizure prophylaxis, traumatic brain injury, posttraumatic seizure