Assessing risk factors associated with breakthrough early post-traumatic seizures in patients receiving phenytoin prophylaxis
ObjectivePost-traumatic seizure (PTS) is a well-known complication of traumatic brain injury (TBI). The objective of this study was to identify risk factors associated with breakthrough early PTS in TBI patients receiving phenytoin prophylaxis.MethodsThis was a single-centered retrospective study in...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1329042/full |
| _version_ | 1797366121607725056 |
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| author | Eugene Generoso Calvin Diep Carolyn Hua Elizabeth Rader Ran Ran Nathanael J. Lee Lucia Rivera-Lara |
| author_facet | Eugene Generoso Calvin Diep Carolyn Hua Elizabeth Rader Ran Ran Nathanael J. Lee Lucia Rivera-Lara |
| author_sort | Eugene Generoso |
| collection | DOAJ |
| description | ObjectivePost-traumatic seizure (PTS) is a well-known complication of traumatic brain injury (TBI). The objective of this study was to identify risk factors associated with breakthrough early PTS in TBI patients receiving phenytoin prophylaxis.MethodsThis was a single-centered retrospective study including adult patients admitted to the intensive care unit (ICU), had a TBI, and started on phenytoin for seizure prophylaxis within 24 h of admission. The primary outcome was the incidence and factors associated with early PTS, defined as a confirmed seizure on a continuous electroencephalogram within 7 days of TBI. Secondary outcomes included the association between early post-traumatic seizures and ICU length of stay, hospital length of stay, and in-hospital mortality.ResultsA total of 105 patients were included in the final analysis. Patients with early PTS were older (65 vs. 48 years old, p = 0.01), had a higher Marshall score (5 vs. 2, p = 0.01), were more likely to have a Marshall score > 2 (73 vs. 37%, p = 0.01), and had more neurosurgeries for hematoma evacuation (57 vs. 19%, p = 0.01). In patients with early PTS, 57% had a level at the time of seizure, and of those, 87.5% had a therapeutic level (>10 mcg/mL). Patients with early PTS had a longer ICU length of stay (14.7 vs. 5.9 days, p = 0.04) and a greater proportion of hospital mortality (21 vs. 2%, p = 0.02).ConclusionPatients with higher age, Marshall score, and neurosurgical procedures for hematoma evacuation had higher incidences of breakthrough early PTS despite the use of phenytoin prophylaxis. The majority of patients with early PTS had therapeutic phenytoin levels at the time of seizure when a level was available; however, approximately half (43%) did not have a level. |
| first_indexed | 2024-03-08T16:59:50Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-08T16:59:50Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-587d66ffe7284dc2ba6f587cf0be72872024-01-04T14:36:50ZengFrontiers Media S.A.Frontiers in Neurology1664-22952024-01-011410.3389/fneur.2023.13290421329042Assessing risk factors associated with breakthrough early post-traumatic seizures in patients receiving phenytoin prophylaxisEugene Generoso0Calvin Diep1Carolyn Hua2Elizabeth Rader3Ran Ran4Nathanael J. Lee5Lucia Rivera-Lara6Department of Pharmacy, Stanford Health Care, Palo Alto, CA, United StatesDepartment of Pharmacy, Stanford Health Care, Palo Alto, CA, United StatesDepartment of Pharmacy, Stanford Health Care, Palo Alto, CA, United StatesDepartment of Pharmacy, Stanford Health Care, Palo Alto, CA, United StatesDepartment of Emergency and Critical Care Medicine, Oregon Health & Science University, Portland, OR, United StatesDepartment of Neurology, Stanford Health Care, Palo Alto, CA, United StatesDepartment of Neurology, Stanford Health Care, Palo Alto, CA, United StatesObjectivePost-traumatic seizure (PTS) is a well-known complication of traumatic brain injury (TBI). The objective of this study was to identify risk factors associated with breakthrough early PTS in TBI patients receiving phenytoin prophylaxis.MethodsThis was a single-centered retrospective study including adult patients admitted to the intensive care unit (ICU), had a TBI, and started on phenytoin for seizure prophylaxis within 24 h of admission. The primary outcome was the incidence and factors associated with early PTS, defined as a confirmed seizure on a continuous electroencephalogram within 7 days of TBI. Secondary outcomes included the association between early post-traumatic seizures and ICU length of stay, hospital length of stay, and in-hospital mortality.ResultsA total of 105 patients were included in the final analysis. Patients with early PTS were older (65 vs. 48 years old, p = 0.01), had a higher Marshall score (5 vs. 2, p = 0.01), were more likely to have a Marshall score > 2 (73 vs. 37%, p = 0.01), and had more neurosurgeries for hematoma evacuation (57 vs. 19%, p = 0.01). In patients with early PTS, 57% had a level at the time of seizure, and of those, 87.5% had a therapeutic level (>10 mcg/mL). Patients with early PTS had a longer ICU length of stay (14.7 vs. 5.9 days, p = 0.04) and a greater proportion of hospital mortality (21 vs. 2%, p = 0.02).ConclusionPatients with higher age, Marshall score, and neurosurgical procedures for hematoma evacuation had higher incidences of breakthrough early PTS despite the use of phenytoin prophylaxis. The majority of patients with early PTS had therapeutic phenytoin levels at the time of seizure when a level was available; however, approximately half (43%) did not have a level.https://www.frontiersin.org/articles/10.3389/fneur.2023.1329042/fulltraumatic brain injurypost-traumatic epilepsyphenytoinrisk factorsseizure prophylaxis |
| spellingShingle | Eugene Generoso Calvin Diep Carolyn Hua Elizabeth Rader Ran Ran Nathanael J. Lee Lucia Rivera-Lara Assessing risk factors associated with breakthrough early post-traumatic seizures in patients receiving phenytoin prophylaxis Frontiers in Neurology traumatic brain injury post-traumatic epilepsy phenytoin risk factors seizure prophylaxis |
| title | Assessing risk factors associated with breakthrough early post-traumatic seizures in patients receiving phenytoin prophylaxis |
| title_full | Assessing risk factors associated with breakthrough early post-traumatic seizures in patients receiving phenytoin prophylaxis |
| title_fullStr | Assessing risk factors associated with breakthrough early post-traumatic seizures in patients receiving phenytoin prophylaxis |
| title_full_unstemmed | Assessing risk factors associated with breakthrough early post-traumatic seizures in patients receiving phenytoin prophylaxis |
| title_short | Assessing risk factors associated with breakthrough early post-traumatic seizures in patients receiving phenytoin prophylaxis |
| title_sort | assessing risk factors associated with breakthrough early post traumatic seizures in patients receiving phenytoin prophylaxis |
| topic | traumatic brain injury post-traumatic epilepsy phenytoin risk factors seizure prophylaxis |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1329042/full |
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