Controlling seizure activity is paramount in the early stages of traumatic brain injury to avoid hypoxia and aspiration, as well as an elevation of ICP and possible herniation.

If the seizure occurred, the most appropriate anticonvulsant therapy is warranted. What is the most appropriate initial treatment for seizures in this situation?

 Seizures are easily managed within the first several days of TBI and preventing them is important to avoid hypoxia, aspiration, increase in ICP and possibility of herniation. These problems can be made worse by the seizures and has been found to have a great effect on the life of patients. The initial treatment for seizures in this context typically involves the following:The initial treatment for seizures in this context typically involves the following:

 First Line Management of Seizures in TBI

 Benzodiazepines:

 Medications: Lorazepam (Ativan) or Midazolam (Versed) are the most commonly used intravenous anaesthetic agents.

 Rationale: This class has a rapid onset of action and is useful in the swift management of acute seizures. The devices also have a relatively beneficial safety profile especially when used in the short-term.

 Dosage and Administration:

 Lorazepam: 4 mg by IV bolus over 2 minutes; may again be given in 10-15 minutes if the seizures continue.

 Midazolam: 5-10 mg; IV push; may repeat depending on response and clinical rationale.

 Anticonvulsant Therapy:

 Once status epilepticus has been controlled with benzodiazepines, the long-term treatment of seizures is done through the use of antiepileptic drugs (AEDs).

 Short acting barbiturate or IV valproate is sometimes used in combination with phenytoin (Dilantin) or fosphenytoin (Cerebyx) for status epilepticus treatment.

 Dosage and Administration:

 Phenytoin: This initial dose is 15-20 mg/kg IV (infra), though this is often administered over 30 minutes.

 Fosphenytoin: 15-20 mg PE/kg IV (phenytoin has slower administration rate).

 Continuous Monitoring:

 Assess the patient for the reappearance of the seizures, the patient’s general health status and complications of medications.

 Video EEG monitoring may be necessary in cases when seizures are recurrent or clinically intractable.

 Rationale for Initial Treatment

 Benzodiazepines are preferred initially as they offer a rapid onset of effect, which is essential as far as the resorber is concerned and focuses on the acute seizures and the elimination of the immediate complications.

 Phenytoin or Fosphenytoin is given as first-line in the long-term preventative treatment to reduce any further Seizures specially in clients who have sustained TBI and are at higher risk of developing post-traumatic Seizures.

 Follow-Up and Considerations

 Re-evaluation: Determination of patient’s neurologic status and response to the treatment should be done more often.

 Adjustment: The doses may be changed depending on the seizure frequency, side effects, and tdm especially in drugs such as phenytoin.

 Seizures that occur in conferlation with TBI needs to be promptly diagnosed and properly managed to prevent complications that may hinder favourable recovery.