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PHENYTOIN PREVENTS EARLY SEIZURES AFTER HEAD TRAUMA.

Although phenytoin is frequently used to prevent seizures in patients with major head injuries, no definitive studies have supported this practice. These Seattle researchers conducted a prospective, randomized, double- blind trial involving 404 patients with major head injury (cortical contusion as determined by CT; subdural, epidural, or intracerebral hematoma; depressed skull fracture; penetrating injury; seizure within 24 hours of injury; or stupor/coma). As a group, these patients were quite ill: 14 percent died in the first week after injury.

Compared with the placebo group, treated patients had more than a 70 percent reduction in seizures during the first week of treatment (started within 24 hours of injury). On the other hand, phenytoin provided no clear reduction in seizure frequency beyond 8 days after injury.

The study provides clear evidence that phenytoin can potentially reduce the likelihood of seizures in the sickest subset of the nearly 500,000 patients hospitalized annually in the United States for head injury. At the same time, the data provide no basis for routinely continuing phenytoin therapy beyond one to two weeks. Whether the reduction in seizure frequency provides other clinical benefits is still unclear.

— ALK

Published in Journal Watch General Medicine August 31, 1990

Citation(s):

Hauser WA. Prevention of post-traumatic epilepsy. N Engl J Med 1990 Aug 23 323 540-542.

• Medline abstract (Free)

Temkin NR et al. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med 1990 Aug 23 323 497-502.

• Medline abstract (Free)