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Posttraumatic Epilepsy Medication

  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
Updated: Apr 04, 2014

Medication Summary

Early posttraumatic seizure (PTS) is treated with various antiepileptic drugs (AEDs). In most cases, administering the medication via the intravenous (IV) route is desirable, as the patient is still in the recovery stage from the head injury; phenytoin or fosphenytoin is the drug of choice for IV administration for acute seizures.

No evidence suggests that antiepileptic drugs (AEDs) influence the incidence of late PTS; therefore, prophylaxis has no place in caring for patients with head injuries. However, AEDs are effective in patients who develop posttraumatic epilepsy (PTE). The main drugs used for PTE are valproate and carbamazepine.

Also see Antiepileptic Drugs.



Class Summary

These agents prevent seizure recurrence and terminate clinical and electrical seizure activity.

Sodium valproate (Depakote, Depakene, Depacon, Stavzor)


Valproate is chemically unrelated to other antiseizure drugs. Its mechanism of action has not been established; it may be related to increased brain levels of gamma-aminobutyric acid (GABA) or to enhanced GABA action. Valproate may potentiate postsynaptic GABA responses, affect the potassium channel, or have a direct membrane-stabilizing effect.

For conversion to monotherapy, the concomitant AED dose is ordinarily reduced by about 25% every 2 weeks. Reduction may start with therapy or delayed 1-2 weeks if seizures are possible with reduction; closely monitor patients during this time for increased seizure frequency.

As adjunctive therapy, valproate may be added to the regimen at 10-15 mg/kg/d. The dosage may increase by 5-10 mg/kg/wk for optimal clinical response. Optimal clinical response is usually achieved at a dose of less than 60 mg/kg/d.

Carbamazepine (Tegretol, Carbatrol, Equetro, Epitol)


Carbamazepine is indicated for complex partial seizures. It may block posttetanic potentiation by reducing summation of temporal stimulation. After therapeutic response, the dose can be reduced to the minimum effective level, or discontinued at least once every 3 months.

Phenytoin (Dilantin, Phenytek)


Phenytoin may act in the motor cortex, inhibiting spread of seizure activity; it may inhibit activity of brainstem centers responsible for the tonic phase of grand mal seizures.

Dosages must be individualized. Administer a larger dose before sleep if the dose cannot be divided equally. To minimize GI irritation, administer with or immediately after meals. Rapid injection or direct IV injection may cause severe hypotension or CNS depression.

Topiramate (Topamax)


Topiramate is a sulfamate-substituted monosaccharide with a broad spectrum of antiepileptic activity that may have state-dependent sodium channel blocking action, potentiating the inhibitory activity of the neurotransmitter gamma-aminobutyrate (GABA). It may block glutamate activity.

Levetiracetam (Keppra)


Levetiracetam is used as adjunctive therapy for partial seizures and myoclonic seizures. It is also indicated for primary generalized tonic-clonic seizures. Its mechanism of action is unknown.

Contributor Information and Disclosures

David Y Ko, MD Associate Professor of Clinical Neurology, Associate Director, USC Adult Epilepsy Program, Keck School of Medicine of the University of Southern California

David Y Ko, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Clinical Neurophysiology Society

Disclosure: Received honoraria from UCB for speaking and teaching; Received consulting fee from Lundbeck for consulting; Received consulting fee from Westward for consulting; Received consulting fee from Esai for consulting; Received consulting fee from Supernus for consulting; Received consulting fee from Sunovion for speaking and teaching.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jose E Cavazos, MD, PhD, FAAN, FANA, FACNS Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, Assistant Dean for the MD/PhD Program, Program Director of the Clinical Neurophysiology Fellowship, University of Texas School of Medicine at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center, University Hospital System; Director, San Antonio Veterans Affairs Epilepsy Center of Excellence and Neurodiagnostic Centers, Audie L Murphy Veterans Affairs Medical Center

Jose E Cavazos, MD, PhD, FAAN, FANA, FACNS is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Neurological Association, Society for Neuroscience, American Epilepsy Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Brain Sentinel, consultant.<br/>Stakeholder (<5%), Co-founder for: Brain Sentinel.

Chief Editor

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cyberonics; Eisai; Lundbeck; Sunovion; UCB; Upsher-Smith<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cyberonics; Eisai; Glaxo Smith Kline; Lundbeck; Sunovion; UCB<br/>Received research grant from: Cyberonics; Lundbeck; Sepracor; Sunovion; UCB; Upsher-Smith.


Nicholas Lorenzo, MD, CPE Chairman and CEO, Neurology Specialists and Consultants; Senior Vice President, Founding Executive Director, Continuing Medical Education, Gannett Education (Division Gannett Healthcare Group)

Nicholas Lorenzo, MD, CPE is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

Ewa Posner, MD, MRCP Consultant Pediatrician, Department of Pediatrics, University Hospital of North Durham, UK

Ewa Posner, MD, MRCP is a member of the following medical societies: European Paediatric Neurology Society and Royal College of Paediatrics and Child Health

Disclosure: Nothing to disclose.

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