This document presents an evidence based surgery presentation on the use of prophylactic anticonvulsants for traumatic brain injury. It includes a case study of a 50 year old man who suffered a moderate traumatic brain injury and was given phenytoin for one week. The presentation reviews the PICO question of whether prophylactic anticonvulsants are effective for any patients with traumatic brain injury. It then outlines the literature search methodology and key findings, including that prophylactic phenytoin reduces early seizures after injury but not thereafter, and there is a role in suppressing early seizures for moderate to severe head injuries. Indications for use are also presented.

1. Evidence Based Surgery
Shinuo Liu
Dr Andrew Davidson
16/08/12
EBS presentation 1

2. Case
50 year old RHD CEO.
Tripped over dog. Moderate TBI.
Observation + PTAs
Put on phenytoin for 1 week.
EBS presentation 2

3. PICO
P = in ALL patients with traumatic brain injury
I = prophylactic anticonvulsants
C=
O = does it work? Is there a role?
EBS presentation 3

4. Keywords
• Traumatic brain injury
• Head injury
• Brain injury
• Anticonvulsant*
• Antiepileptic*
• Prophyla*
• Prevent*
EBS presentation 4

5. MEDLINE
EBS presentation 5

6. EBS presentation 6

7. SCOPUS
EBS presentation 7

8. EMBASE
EBS presentation 8

9. EBS presentation 9

10. Summary
Prophylactic phenytoin reduces the incidence of
seizure in the first week after injury but not
thereafter (?CMZ/PHB/VPA).
There is a role in suppression of early seizures
in moderate to severe head injury.
EBS presentation 10

11. Indications (Khan and Banerjee (2010) Int J Emerg Med;
3:187–191)
• GCS score <10
• Cortical contusions
• Depressed skull fracture
• Subdural haematoma
• Epidural haematoma
• Intracerebral haematoma
• Penetrating head wound
EBS presentation 11

12. Our case
Supported by evidence!
EBS presentation 12

13. EBS presentation 13

14. EBS presentation 14

15. EBS presentation 15

16. EBS presentation 16