The Pros and Cons of Taking Preventative Anti-Seizure Meds
Four months ago, my husband sustained a TBI in a car wreck. He has never had a seizure, but should he be on an anti-seizure medicine to prevent him from having one?
It's an interesting question with regard to seizure medications. The risk of seizure varies greatly, depending on the severity of the traumatic brain injury. Those with milder brain injuries like a concussion, probably their risk of seizures is not much higher than the general population at 5% or less. In people with much more severe brain injuries, particularly if there is a skull fracture and indural penetration, where there is actually a penetration into the brain, the risk can be as high as 25% to 50%, so that in itself certainly plays a role in making decisions on seizure medications. The standard of treatment in people who haven't had any seizures would be to continue seizure medication for just one week. and not to continue seizure medication longer than that. There is no good data to say that if you keep people on seizure medication longer that that will prevent them from having a seizure. There is some interesting research data to say actually that seizure medications can't prevent people from having seizures long term. In people who have known seizures, you certainly want to start them on an appropriate seizure medication. The downside, I'd say, to just keeping people on seizure medication without it being--without a clear reason for it, is that what are the side effects of most seizure medications--? memory problems, fatigue, difficulty with arousal. One of the common problems that we see after a brain injury--memory problems, fatigue, difficulty arousal--and so, unfortunately, seizure medications can really compound some of the common problems that we see after traumatic brain injury, so I do the best I can and try to get-- unless there is a clear indication for it, I try to get people off of seizure medications.
Posted on BrainLine August 30, 2011.
Dr. Brian Greenwald is medical director of Center for Head Injuries and the associate medical director of JFK Johnson Rehabilitation Institute. He is a clinical associate professor in the Department of Physical Medicine and Rehabilitation at UMDNJ-Robert Wood Johnson Medical School.