การใช้ยาเพื่อป้องกันภาวะชักในระยะแรกของกลุ่มผู้ป่วยบาดเจ็บที่สมอง การศึกษาเชิงสังเกตที่ติดตามไปข้างหน้า

Abstract

The use of antiepileptic drug (AED) for preventing early posttraumatic seizure (PTS) is recommended by various guideline in a high-risk traumatic brain injury (TBI) patient. Although phenytoin is currently recommended as the drug of choice for early PTS prophylaxis, several drug-related problems are reported with the use of phenytoin. Therefore, other AEDs have been used for early PTS prophylaxis or some TBI patients did not receive AED prophylaxis. A prospective cohort study was conducted to explore AED used for early PTS prophylaxis in TBI patients, to examine the outcomes of patients who received phenytoin and valproate, and to examine the outcomes of patients who received and did not receive the AED for early PTS prophylaxis. All TBI patients admitted to two level I trauma centers, Songklanakarind and Hatyai Hospital, during April 2017 to March 2018 were enrolled and selected by consecutive sampling. Four hundred eighty four TBI patients were studied and 53.7% of the patients received AED for PTS prophylaxis. The most commonly used AED was phenytoin (90.7%) followed by valproate (6.9%) and levetiracetam (2.3%). Twenty- seven patients developed seizures within 7-day following TBI. Of this, 15 patients developed seizures before the AED initiation. Based on the Clinical Practice Guideline of Traumatic Brain Injury (Thailand) 2013 recommendation, 286 patients were classified as a high risk for PTS. Of this, 85% of the patients received AED for early PTS prophylaxis. For the high risk of PTS patients receiving phenytoin prophylaxis (n = 220), there were 11 patients (5%) developed early PTS and 26 patients (11.9%) died within 3 months. Ten patients developed skin rash while receiving phenytoin; one of them had Stevens-Johnson syndrome/toxic epidermal necrolysis overlap. For the high risk of PTS patients receiving valproate prophylaxis (n = 17), none of the patients developed early PTS or adverse drug reaction. For the patients receiving any AED prophylaxis (n = 243), there were 12 patients (4.9%) developed early PTS and 27 patients (11.1%) died within 3 months. For those who did not receive AED prophylaxis, none of the patients developed early PTS or death. In conclusion, the high-risk TBI patients received AED prophylaxis and complied with the Thai guideline. Phenytoin remained the most commonly used AED for prophylaxis. However, this study would not be compared the efficacy and safety of phenytoin and valproate or the difference between the group receiving PTS prophylaxis and non-prophylaxis.