Post-traumatic epilepsy: current and emerging treatment options

Jerzy P Szaflarski,1,3 Yara Nazzal,1,3 Laura E Dreer2 1Department of Neurology, 2Department of Ophthalmology, 3UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA Abstract: Traumatic brain injury (TBI) leads to many undesired problems and complications, including immedia...

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Autores principales:	Szaflarski JP, Nazzal Y, Dreer LE
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/4ba1066e0a2a4844bf1edd20c5887180
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spelling	oai:doaj.org-article:4ba1066e0a2a4844bf1edd20c58871802021-12-02T04:32:55ZPost-traumatic epilepsy: current and emerging treatment options1178-2021https://doaj.org/article/4ba1066e0a2a4844bf1edd20c58871802014-08-01T00:00:00Zhttp://www.dovepress.com/post-traumatic-epilepsy-current-and-emerging-treatment-options-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021 Jerzy P Szaflarski,1,3 Yara Nazzal,1,3 Laura E Dreer2 1Department of Neurology, 2Department of Ophthalmology, 3UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA Abstract: Traumatic brain injury (TBI) leads to many undesired problems and complications, including immediate and long-term seizures/epilepsy, changes in mood, behavioral, and personality problems, cognitive and motor deficits, movement disorders, and sleep problems. Clinicians involved in the treatment of patients with acute TBI need to be aware of a number of issues, including the incidence and prevalence of early seizures and post-traumatic epilepsy (PTE), comorbidities associated with seizures and anticonvulsant therapies, and factors that can contribute to their emergence. While strong scientific evidence for early seizure prevention in TBI is available for phenytoin (PHT), other antiepileptic medications, eg, levetiracetam (LEV), are also being utilized in clinical settings. The use of PHT has its drawbacks, including cognitive side effects and effects on function recovery. Rates of recovery after TBI are expected to plateau after a certain period of time. Nevertheless, some patients continue to improve while others deteriorate without any clear contributing factors. Thus, one must ask, ‘Are there any actions that can be taken to decrease the chance of post-traumatic seizures and epilepsy while minimizing potential short- and long-term effects of anticonvulsants?’ While the answer is ‘probably,’ more evidence is needed to replace PHT with LEV on a permanent basis. Some have proposed studies to address this issue, while others look toward different options, including other anticonvulsants (eg, perampanel or other AMPA antagonists), or less established treatments (eg, ketamine). In this review, we focus on a comparison of the use of PHT versus LEV in the acute TBI setting and summarize the clinical aspects of seizure prevention in humans with appropriate, but general, references to the animal literature. Keywords: traumatic brain injury, TBI, seizures, epilepsy, seizure prevention, cognition, EEG, antiepileptic drugsSzaflarski JPNazzal YDreer LEDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2014, Iss default, Pp 1469-1477 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Szaflarski JP Nazzal Y Dreer LE Post-traumatic epilepsy: current and emerging treatment options
description	Jerzy P Szaflarski,1,3 Yara Nazzal,1,3 Laura E Dreer2 1Department of Neurology, 2Department of Ophthalmology, 3UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA Abstract: Traumatic brain injury (TBI) leads to many undesired problems and complications, including immediate and long-term seizures/epilepsy, changes in mood, behavioral, and personality problems, cognitive and motor deficits, movement disorders, and sleep problems. Clinicians involved in the treatment of patients with acute TBI need to be aware of a number of issues, including the incidence and prevalence of early seizures and post-traumatic epilepsy (PTE), comorbidities associated with seizures and anticonvulsant therapies, and factors that can contribute to their emergence. While strong scientific evidence for early seizure prevention in TBI is available for phenytoin (PHT), other antiepileptic medications, eg, levetiracetam (LEV), are also being utilized in clinical settings. The use of PHT has its drawbacks, including cognitive side effects and effects on function recovery. Rates of recovery after TBI are expected to plateau after a certain period of time. Nevertheless, some patients continue to improve while others deteriorate without any clear contributing factors. Thus, one must ask, ‘Are there any actions that can be taken to decrease the chance of post-traumatic seizures and epilepsy while minimizing potential short- and long-term effects of anticonvulsants?’ While the answer is ‘probably,’ more evidence is needed to replace PHT with LEV on a permanent basis. Some have proposed studies to address this issue, while others look toward different options, including other anticonvulsants (eg, perampanel or other AMPA antagonists), or less established treatments (eg, ketamine). In this review, we focus on a comparison of the use of PHT versus LEV in the acute TBI setting and summarize the clinical aspects of seizure prevention in humans with appropriate, but general, references to the animal literature. Keywords: traumatic brain injury, TBI, seizures, epilepsy, seizure prevention, cognition, EEG, antiepileptic drugs
format	article
author	Szaflarski JP Nazzal Y Dreer LE
author_facet	Szaflarski JP Nazzal Y Dreer LE
author_sort	Szaflarski JP
title	Post-traumatic epilepsy: current and emerging treatment options
title_short	Post-traumatic epilepsy: current and emerging treatment options
title_full	Post-traumatic epilepsy: current and emerging treatment options
title_fullStr	Post-traumatic epilepsy: current and emerging treatment options
title_full_unstemmed	Post-traumatic epilepsy: current and emerging treatment options
title_sort	post-traumatic epilepsy: current and emerging treatment options
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/4ba1066e0a2a4844bf1edd20c5887180
work_keys_str_mv	AT szaflarskijp posttraumaticepilepsycurrentandemergingtreatmentoptions AT nazzaly posttraumaticepilepsycurrentandemergingtreatmentoptions AT dreerle posttraumaticepilepsycurrentandemergingtreatmentoptions
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Post-traumatic epilepsy: current and emerging treatment options

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