Effectiveness of Early Antiepileptic Prophylaxis in Preventing Post-Traumatic Seizures among Patients with Head Injury in Emergency Care Settings
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Background: Post-traumatic seizures are a significant complication of traumatic brain injury, contributing to secondary neurological injury and adverse clinical outcomes, particularly in emergency care settings with limited resources. Objective: To evaluate the occurrence of early post-traumatic seizures among patients receiving antiepileptic prophylaxis and to identify clinical predictors associated with seizure risk. Methods: This prospective observational study included 207 adult patients presenting within 24 hours of head injury to a tertiary care emergency department. All patients received early antiepileptic prophylaxis and were followed for seizure occurrence during hospitalization and within seven days post-injury. Baseline variables including Glasgow Coma Scale, mechanism of injury, and radiological findings were recorded, and associations were analyzed using Chi-square tests and multivariable logistic regression. Results: Seizures occurred in 45 patients (21.7%). Seizure frequency increased significantly with injury severity, from 8.1% in mild to 34.1% in moderate and 75.0% in severe traumatic brain injury (p < 0.001). Radiological abnormalities showed a strong gradient association, with seizure rates of 8.8% in normal imaging, 23.8% in contusions, 50.0% in epidural hematoma, and 100.0% in subdural hematoma (p < 0.001). Differences in seizure occurrence across antiepileptic drugs were observed but were not consistently statistically significant. Conclusion: Early post-traumatic seizures remain frequent despite prophylactic therapy and are strongly associated with injury severity and structural brain lesions, highlighting the importance of risk-based monitoring and targeted clinical management.
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