Early Seizure Prophylaxis in Mild and Moderate Traumatic Brain Injury

作者：Matthew Pease, Adi Mittal, Sara Merkaj, David O. Okonkwo, Jorge González-Martínez, Jonathan Elmer, Wen‐Shyong Liou, Valeria Pingue, Flora M. Hammond, Sergiu Abramovici, James F. Castellano, Niravkumar Barot · 发表于：JAMA Neurology · 年份：2024 · DOI：10.1001/jamaneurol.2024.0689 · 被引用次数：30 · 研究领域：Traumatic Brain Injury and Neurovascular Disturbances、Traumatic Brain Injury Research、Epilepsy research and treatment

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 screen...