Practice parameter: antiepileptic drug treatment of posttraumatic seizures. Brain Injury Special Interest Group of the American Academy of Physical Medicine and Rehabilitation.

The practice of antiepileptic drug (AED) prophylaxis for posttraumatic seizures (PTS) is common, although results of clinical trials raise questions regarding the benefits of such treatment. A subcommittee of the Brain Injury Special Interest Group of the American Academy of Physical Medicine and Rehabilitation was impaneled to review published literature regarding AED prophylaxis of PTS and formulate recommendations in the form of a practice parameter. The subcommittee presents the following recommendations: (1) Treatment standard: Prophylactic use of phenytoin (PHT), carbamazepine (CBZ), sodium valproate (VPA), or phenobarbital (PB) is not recommended for preventing late PTS, defined as seizures that occur after 1 week of injury, in the patient in whom there has been no history of seizures following a nonpenetrating traumatic brain injury (TBI). (2) It is recommended as a treatment option that PHT, PB, and CBZ may be used to prevent early PTS in patients at high risk for seizures following TBI. (3) Prophylactic use of PHT, CBZ, VPA, or PB is not recommended for preventing late PTS following penetrating TBI.