Antiepileptic Therapy Duration After Head Injury

Evidence-Based Guidelines

• The American Heart Association recommends that risk scores should not be used to guide continuation of antiepileptic drugs beyond the acute period, as they do not predict who will benefit from extended treatment 1, 2, 3
• For a single unprovoked seizure with remote history of brain injury, the American College of Emergency Physicians suggests considering treatment initiation or defer in coordination with neurology 4
• The Infectious Diseases Society of America recommends that if a patient is seizure-free for 24 consecutive months after resolution of structural lesions on imaging, consideration should be given to tapering and stopping antiepileptic drugs 5

Medication Selection and Management

• The American Academy of Neurology implies that prophylactic antiepileptic drugs may negatively affect specific cognitive domains even when global functional outcomes appear unchanged 1, 2, 3
• Phenytoin should not be used long-term due to negative cognitive effects and side effect profile, according to the American Heart Association 6