A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures.
- Jan 11, 2022
Temkin NR, Dikmen SS, Wilensky AJ, Keihm J, Chabal S, Winn HR
- Purpose: Study phenytoin’s effectiveness in preventing post-traumatic seizures in early (first 7 days) and late (8 days to 1 year) time period
- Patients admitted to a single institution from 1983-1987 with serious head trauma (defined as cortical contusion, subdural, epidural, intracerebral hemtoma, depressed skull fracture, a penetrating head wound, seizure within 24 hours of injury, or GCS score <10 on admission) were included in the study, 404 patients total
- Patients were assigned to treatment with phenytoin or placebo in a double blind fashion. Patients were dosed with 20 mg/kg within 24 hours, then doses were adjusted by serum phenytoin level (ranged from 200 to 2600 mg daily).
- Patients were kept on the medication for one year. Phenytoin levels were monitored every three months during clinic visits, with dosage adjusted to maintain high therapeutic range. Medication was tapered and stopped if patients had no seizures by one year.
- As compared with the placebo group, patients who received phenytoin had a 73% decrease in the risk of seizures in the first week. No benefit was detected after day 8.
- Authors conclude that phenytoin reduces the incidence of seizures in the first week after injury but not later.
N Engl J Med. 1990 Aug 23;323(8):497-502. doi: 10.1056/NEJM199008233230801. PMID: 2115976