Abstract
Objective:
To identify the effectiveness of prophylactic phenytoin in preventing posttraumatic epilepsy.
Design:
Retrospective cohort study.
Setting:
Urban tertiary-care hospital and trauma center.
Subjects:
Patients admitted to the trauma service in 1989 with moderate to severe head injury surviving to discharge.
Interventions:
Divided into two groups based on prophylaxis with phenytoin.
Measurements and Main Results:
Ninety-one patients with moderate to severe head injury were admitted during the study period; 6 were excluded from analysis for prehospital seizure activity. Forty-one patients received no anticonvulsants; 44 received phenytoin alone or in combination with other agents. None of the patients experienced a seizure during hospitalization. Seventy-four percent of all phenytoin concentrations were subtherapeutic (serum phenytoin 10–20 μg/mL).
Conclusions:
The lack of seizure activity in the face of absent or subtherapeutic phenytoin concentrations brings into question the benefit of prophylactic therapy.
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