TY - JOUR
T1 - Pharmacological management of post-traumatic seizures in adults
T2 - current practice patterns in the UK and the Republic of Ireland
AU - Mee, Harry
AU - Kolias, Angelos G
AU - Chari, Aswin
AU - Ercole, Ari
AU - Lecky, Fiona
AU - Turner, Carole
AU - Tudur-Smith, Catrin
AU - Coles, Jonathan
AU - Anwar, Fahim
AU - Belli, Antonio
AU - Manford, Mark
AU - Ham, Timothy
AU - McMahon, Catherine
AU - Bulters, Diederik
AU - Uff, Chris
AU - Duncan, John S
AU - Wilson, Mark H
AU - Marson, Anthony G
AU - Hutchinson, Peter J
PY - 2019/3
Y1 - 2019/3
N2 - BACKGROUND: Patient selection for seizure prophylaxis after traumatic brain injury (TBI) and duration of anti-epileptic drug treatment for patients with early post-traumatic seizures (PTS), remain plagued with uncertainty. In early 2017, a collaborative group of neurosurgeons, neurologists, neurointensive care and rehabilitation medicine physicians was formed in the UK with the aim of assessing variability in current practice and gauging the degree of uncertainty to inform the design of future studies. Here we present the results of a survey of clinicians managing patients with TBI in the UK and Ireland.MATERIALS AND METHODS: An online survey was developed and piloted. Following approval by the Academic Committee of the Society of British Neurological Surgeons, it was distributed via appropriate electronic mailing lists.RESULTS: One hundred and seventeen respondents answered the questionnaire, predominantly neurosurgeons (76%) from 30 (of 32) trauma-receiving hospitals in the UK and Ireland. Fifty-three percent of respondents do not routinely use seizure prophylaxis, but 38% prescribe prophylaxis for one week. Sixty percent feel there is uncertainty regarding the use of seizure prophylaxis, and 71% would participate in further research to address this question. Sixty-two percent of respondents use levetiracetam for treatment of seizures during the acute phase, and 42% continued for a total of 3 months. Overall, 90% were uncertain about the duration of treatment for seizures, and 78% would participate in further research to address this question.CONCLUSION: The survey results demonstrate the variation in practice and uncertainty in both described aspects of management of patients who have suffered a TBI. The majority of respondents would want to participate in future research to help try and address this critical issue, and this shows the importance and relevance of these two clinical questions.
AB - BACKGROUND: Patient selection for seizure prophylaxis after traumatic brain injury (TBI) and duration of anti-epileptic drug treatment for patients with early post-traumatic seizures (PTS), remain plagued with uncertainty. In early 2017, a collaborative group of neurosurgeons, neurologists, neurointensive care and rehabilitation medicine physicians was formed in the UK with the aim of assessing variability in current practice and gauging the degree of uncertainty to inform the design of future studies. Here we present the results of a survey of clinicians managing patients with TBI in the UK and Ireland.MATERIALS AND METHODS: An online survey was developed and piloted. Following approval by the Academic Committee of the Society of British Neurological Surgeons, it was distributed via appropriate electronic mailing lists.RESULTS: One hundred and seventeen respondents answered the questionnaire, predominantly neurosurgeons (76%) from 30 (of 32) trauma-receiving hospitals in the UK and Ireland. Fifty-three percent of respondents do not routinely use seizure prophylaxis, but 38% prescribe prophylaxis for one week. Sixty percent feel there is uncertainty regarding the use of seizure prophylaxis, and 71% would participate in further research to address this question. Sixty-two percent of respondents use levetiracetam for treatment of seizures during the acute phase, and 42% continued for a total of 3 months. Overall, 90% were uncertain about the duration of treatment for seizures, and 78% would participate in further research to address this question.CONCLUSION: The survey results demonstrate the variation in practice and uncertainty in both described aspects of management of patients who have suffered a TBI. The majority of respondents would want to participate in future research to help try and address this critical issue, and this shows the importance and relevance of these two clinical questions.
KW - Anticonvulsants/administration & dosage
KW - Brain Injuries, Traumatic/complications
KW - Drug Utilization/standards
KW - Humans
KW - Ireland
KW - Levetiracetam/administration & dosage
KW - Seizures/drug therapy
KW - Surveys and Questionnaires
KW - United Kingdom
U2 - 10.1007/s00701-018-3683-9
DO - 10.1007/s00701-018-3683-9
M3 - Article
C2 - 30276544
SN - 0001-6268
VL - 161
SP - 457
EP - 464
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
IS - 3
ER -