Post-Traumatic Seizure

[wickedskillz]

Hey guys,

I wanted to check to see what people are using for post-traumatic seizure prophylaxis. My hospital is defnitely not up to par according to the literature, but I guess it seems to work. We use Phenytoin 100 mg tid with no loading dose. I'm assuming that patients are sub-therepeutic fairly often, especially near the beginning, but we rarely check levels (unless the pt actually seizes) so I can't say for sure either way. I just wanted to get a feel of what people are doing out there...

Also, has anyone started using Keppra, Vimpat or anything besides dilantin? Is anyone thinking about it?

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[Stitch]

We use keppra at my shop. It's neurology and neurosurgery's preference, but I don't know there's a lot of literature to support one versus another. I have seen a terrible SJS/TEN secondary to phenytoin, so in my eyes keppra's a safer drug with a much wider therapeutic index.

 

[michigangirl]

agree with stitch. Keppra has become the new love of neurology and neurosurgery. All of our pediatric TBIs who meet criteria for seizure prophylaxis get keppra bid. Not sure what's done in adults, but our adult-size kids (>15) get the same thing.

 

[jdh71]

You'd think the makers of Keppra would fund a study - get a new indication. Or did Keppra go generic when I wasn't looking?

I've seen both used. Without any anecdotal difference noted really.

 

[Doctor4Life1769]

keppra.

 

[dotcb]

Not all patients are prophylaxed, but when given - it's phenytoin for a week w/ a loading dose.