Closed Head Injury Medication

Updated: Feb 24, 2016
  • Author: Leonardo Rangel-Castilla, MD; Chief Editor: Brian H Kopell, MD  more...
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Medication Summary

Neurosurgeons have commonly given prophylactic anticonvulsants for individuals with intracranial hemorrhages. The appropriate duration of treatment is not well established. Individuals who have experienced seizure activity can reasonably be treated with anticonvulsants for 6-12 months, after which reevaluation is necessary. Temkin and colleagues suggest that treatment for longer than 8 days after injury does not reduce the frequency of long-term seizure disorders. Anticonvulsants may be used to treat early (< 7 d) posttraumatic seizures. According to Greenberg, prophylactic anticonvulsants do not reduce the frequency of late (>7 d) posttraumatic seizures. [86]

The recommended anticonvulsant medication in adults is phenytoin or fos-phenytoin (18 mg/kg of loading dose), ensuring therapeutic levels of 10-20 mg/dL. Note that a "therapeutic level" does not necessarily have a direct bearing on adequate control of seizures. A relatively common adverse effect of chronic phenytoin use is gingival hyperplasia and hirsutism, which precludes chronic use in children. Phenobarbital is an acceptable alternative in children who require long-term anticonvulsive therapy (10-20 mg/kg loading dose, then 3-5 mg/kg/d divided bid/tid) to achieve a therapeutic level of 10-40 mg/dL.

The new antiepileptic drug levetiracetam is used in the setting of acute brain injury for seizures treatment or prophylaxis; it is a desirable alternative to phenytoin. It is associated with fewer complications when it is used as monotherapy. Checking for therapeutic levels is not needed. The dose is 500 mg bid IV or PO and advance to 1000 mg bid. [87]



Class Summary

These agents are indicated for short-term (1 wk) or long-term (6- to 12-mo) posttraumatic seizure control for patients who have experienced posttraumatic seizure activity. Phenobarbital may be considered in children for long-term anticonvulsive therapy.

Phenytoin (Dilantin)

Used for acute seizure prophylaxis in individuals with closed head injuries.

Phenobarbital (Barbita, Luminal, Solfoton)

Used for acute seizure prophylaxis in children with closed head injuries.