Anticonvulsive prophylaxis of posttraumatic epilepsy in childhood

There is still a considerable controversy about the usefullness of antiepil eptic prophylaxis after traumatic brain injury. Antiepileptic treatment see ms to be effective in preventing early posttraumatic seizures. The publishe d data concerning the effect on late posttraumatic seizures are varying. Mo st of the studies are based on adult patients and it implies difficulties t o transfer these results to the paediatric population. Methods: A retrospec tive analysis of the data of 318 children with civilian brain injuries was performed. The mean age was 6 years and 3 months, the mean follow-up was 9 years. A subgroup of 44 patients was initially treated intravenously with p henobarbitone. Another subgroup of 164 patients received phenobarbitone or carbamazepine for two years after the accident. Results: The overall incide nce of early seizures was 19.8%, of late seizures 21.4%. Main risk factors for the development of late seizures were early seizures, age at accident u nder 2 years, subdural intracranial haemorrhages and brain injuries in batt ered child syndrom. Patients with initial intravenous phenobarbitone treatm ent had significantly less early seizures (6.8% against 30.2%; p < 0.05). P atients receiving antiepileptic treatment for two years prophylactically sh owed no significantly lower incidences of late seizures (24.4% against 33.3 %; p = 0.253). Conclusions: Initial posttraumatic antiepileptic treatment c an reduce early posttraumatic seizures in children. There is no significant preventive effect on late seizures, a risk adapted procedure is recommende d.