Predicting and Treating Post-traumatic Epilepsy

Purpose of Review This is a narrative review of the literature pertaining to early post-traumatic seizures (PTS) and post-traumatic epilepsy (PTE; late, unprovoked seizures), with particular emphasis on current identified biomarkers. We will present the reader current management strategies and society guidelines for the management of PTS. We also indicate potential targets for further investigation to identify patients at high risk for PTE and clinical intervention to prevent PTE. Recent Findings A recent large cohort study again demonstrated that intracranial hemorrhage-including subarachnoid, subdural, and epidural-and severity of head injury were significant risk factors for development of PTS. While several prior studies have shown the efficacy of antiseizure medications in preventing early PTS in adults, a number of recent retrospective and randomized trials have demonstrated the efficacy of antiseizure medications in preventing early PTS in children. This has prompted new society guidelines for antiseizure medication (ASMs) prophylaxis in pediatric TBI. Recent investigations redemonstrated that early PTS, intracranial hemorrhage, and severity of TBI are major risk factors for PTE. Brief (1-2 weeks) use of prophylactic ASMs-particularly levetiracetam or phenytoin-is effective for the prevention of early PTS in patients with moderate to severe TBI, but prophylactic ASMs for the prevention of PTE are ineffective and not recommended. Continued research into potential biomarkers is needed to identify patients at the highest risk of developing PTE as well as to identify effective therapies for preventing the development of PTE in at-risk patients.