Pharmacologycal Prophylaxis of Early Posttraumatic Epilepsy in 314 Children and Adolescentes

Abstract

Introduction. Early posttraumatic epileptics (EPTE) are epileptic attack that appear in First seven days after brain injury, with incidence of 3-5%. Predictors for development of EPTE are: impressive skull fracture with rupture of dura, intracranial hemorrhage, neurogical deficit (brain contusion), posttraumatic amnesia longer than 24 hours. It is more common in children than in adolescents and adults. It carries four times increased risk for development of late posttraumatic epilepsy. Aspects of pharmacological prophylaxis was often considered, but scientifically neglected, without clear standings regarding controversial data in literature.

Methods. Patients with severe head injury, hospitalized at Neurosurgical Hospital, Clinical Center University of Sarajevo, in period from 6 of April 1992 till 1 01 of July 1994, were included in study. Prophylaxis of EPTE was carried out with Phenobarbital (2-3 mg/kg) or Phenytoin (3mg/kg) parenteray. Decision was made upon clinical findings. CT scan was done in 13,5% patients and in 31,2% patients serum concentrations of antiepileptic drugs were monitored.

Results. 314 patients aged 0-20 years (106 patients 0-10ycars, and 209 patients 11-20 years) were investigated. Predictors of EPTE presented were posttraumatic amnesia longer than 24 hours in 90,4%, neurogical deficit in 86,6%, impressive skull fracture with rupture of dura in 81,5% and intracranial hemorrhage in 41, 1%. Only two boys developed EPTE in first 24 hours after injury.

Conclusion. This study has showed that use of antiepileptic drugs can decrease incidence of EPTE. However, problem remains, management of injured patients is still highly individualized, based on different experiences of doctors that treat patient and without clear guidelines.