The effectiveness and safety of antiepileptic agents in the treatment of acute traumatic head injury were determined at the Institute of Child Health, University College, London, UK, by review of 10 randomized controlled trials involving 2036 patients identified from various databases. The pooled relative risk (RR) for early seizure prevention (within the first week after injury) was 0.34; 10 patients would need to be treated to keep one free from seizures in the acute phase. Seizure control was not accompanied by a reduction in mortality (pooled RR=1.49) or neurological disability. The occurrence of late seizures was not reduced by AEDs; the relative risk of late seizures, based on 4 studies, was 1.28. The risk of skin rashes was increased (RR=1.57). The true net benefit of prophylactic antiepileptic agents was undetermined. [1]

COMMENT. Prophylactic antiepileptic drug therapy initiated after acute head injury may reduce the occurrence of seizures in the first week, but has no effect on the development of late seizures, on mortality or neurological disability, and treatment is associated with the risk of skin rash, a potentially serious side effect. For 100 patients treated 10 may be seizure-free in the first week, but 4 will develop skin rash.

See Progress in Pediatric Neurology II, (PNB Publishers, 1994;ppl37-138) for reports of prophylactic anticonvulsant drugs after craniotomy. In one study from Walton Hospital, Liverpool, UK, skin rashes occurred in 13% of patients treated with carbamazepine or phenytoin (Foy PM et al, 1992), and the occurrence of seizures within the first post-operative week did not increase the likelihood of late epilepsy. The authors concluded that drug therapy should not be recommended routinely following craniotomy.

Endocrine functions following severe head trauma were assessed in 21 children at Chaim Sheba Medical Center, Tel-Hashomer, Israel [2]. Advanced bone age without other signs of precocious puberty were found in 3 prepubescent children. Biochemical and hormonal determinations were normal, and no endocrine abnormalities were found in children examined 4 months or more following injury. Clinical monitoring is sufficient, and specific hormonal measurements are required only when warranted by abnormal signs.