Post-Traumatic Seizure

Aka: Post-Traumatic Seizure, Posttraumatic Seizure, Post Traumatic Seizure

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II. Types

  1. Early Posttraumatic Seizure
    1. Within first 7 days of initial Head Injury
  2. Late Posttraumatic Seizure
    1. Beyond first 7 days from initial Head Injury

III. Risk Factors

  1. Glasgow Coma Scale (GCS) <10
  2. Posttraumatic Amnesia >30 minutes
  3. Skull Fracture
  4. Penetrating Head Trauma
  5. Intracranial Hemorrhage (Subdural Hematoma, Epidural Hematoma)
  6. Seizure within first 24 hours following Head Trauma
  7. Cortical Contusion
  8. Age >65 years old
  9. Chronic Alcoholism

IV. Management

  1. See Status Epilepticus
  2. Seizure Prophylaxis Indications IF risk factors present (see above)
    1. Recommended for early Posttraumatic Seizure (first 7 days) due potential impact on TBI recovery
    2. Not recommended for late Posttraumatic Seizure prophylaxis due to adverse effects
  3. Seizure Prophylaxis Agents
    1. Phenytoin
      1. Recommended by Brain Trauma Foundation
    2. Levetiracetam (Keppra)
      1. Often used in practice

V. Prognosis

  1. Posttraumatic Seizure itself is not associated with worse prognosis
  2. However, Posttraumatic Seizure does occur more commonly with Severe Traumatic Brain Injury

VI. References

  1. Carney (2017) Neurosurgery 80(1): 6-15 [PubMed]
  2. Torbic (2013) Am J Health Syst Pharm 70(9): 759-66 [PubMed]

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