Head injury anticonvulsants

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  1. Post-traumatic epilepsy (PTE) refers to recurrent seizure disorder cause by the injury of the brain and it should be differentiated from post-traumatic seizures (PTS)
  2. PTS are classified as: immediate ( occurence within the first 24 h), early ( occurence within the first week), or late ( occuring after the first week)
  3. Incidence of seizures following penetrating brain injuries is 50% in patients followed for 15 years
  4. Incidence of seizures after closed head injury ranges from 4-25% within 7 days and 9-42% in untreated patients after 7 days
    1. Factors predisposing to PTE: severity of trauma, penetrating head injury, intracranial hematoma, depressed skull fracture, hemorrhagic contusion, coma lasting > 24 h, early seizures
  5. phenytoin, carbamazepine or valproate are recommended to control seizures in the first 7 days following head injury but are not recommended for prophylaxis after 7 days
    1. however, post-traumatic seizure disorders typically develop 6-15 months after trauma
    2. predictors of posttraumatic epilepsy: posttraumatic amnesia, seizure within one week of injury, intracerebral bleeding, decreased serum haptoglobin
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