Association Between Prophylactic Anti-Seizure Medication and Early Post-Traumatic Seizures: An International Observational Multicenter Study

Jian Ji; Juan D. Roa G; Shu-Ling Chong; Quan Wang; Chin Seng Gan; Jane P. W. Ng; Thelma Elvira Teran Miranda; Freddy Israel Pantoja Chamorro; Lawrence Chi Ngong Chan; Qalab Abbas; Jacqueline S. M. Ong; Ivan J. Ardila; Yasser M. Kazzaz; Jesús A. Domínguez-Rojas; Hiroshi Kurosawa; Susana Beatriz Reyes Domínguez; Natalia Elizabeth Gómez Arriola; Natalia Zita Watzlawik; Adriana Yock-Corrales; Rubén Eduardo Lasso Palomino; Gabriela Aparicio; Paula Caporal; Rosa Elena de la Torre Gómez; Chunfeng Liu; Rujipat Samransamruajkit; Nattachai Anantasit; Deborah M. Turina; Marisol Fonseca Flores; Pei-Chuen Lee; Francisco J. Pilar-Orive; Hongxing Dang; Yek Kee Chor; Meixiu Ming; Juan C. Jaramillo-Bustamante; Sebastián González-Dambrauskas; Jan Hau Lee; Suyun Qian

doi:10.1002/mco2.70524

MedComm ›› 2025, Vol. 6 ›› Issue (12) :e70524 DOI: 10.1002/mco2.70524

ORIGINAL ARTICLE

Association Between Prophylactic Anti-Seizure Medication and Early Post-Traumatic Seizures: An International Observational Multicenter Study

Author information +

¹. Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China

². Pediatric Collaborative Latin American Network (LARed Network), Pediatric Intensive Care Unit, Los Cobos Medical Center, Universidad Del Bosque, Bogotá, Colombia

³. Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, SingHealth Duke-NUS Global Health Institute, Duke-NUS Medical School, Singapore, Singapore

⁴. Department of Pediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia

⁵. KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore

⁶. Department of Pediatrics, Hospital Del Niño Manuel Ascencio Villarroel, Cochabamba, Bolivia

⁷. Intensive Care Unit, Hospital Infantil Los Angeles, Pasto, Colombia

⁸. Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China

⁹. Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan

¹⁰. Department of Pediatrics, Yong Loo Lin School of Medicine, Khoo Teck Puat National University Children's Medical Institute, National University Hospital, Singapore, National University of Singapore, Singapore, Singapore

¹¹. Pediatric Critical Care, Clinica UROS, Neiva, Colombia

¹². Department of Pediatrics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

¹³. Department of Pediatrics and Pediatric Critical Care Medicine, Hospital Nacional Hipolito Unanue, El Agustino, Peru, Pediatric Chapter of the Peruvian Society of Intensive Care Medicine, Lima, Peru

¹⁴. Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan

¹⁵. Pediatric Intensive Care Unit, Pediatric Department, Virgen De La Arrixaca Hospital, Murcia, Spain

¹⁶. Emergency Department, Hospital Del Trauma, Asunción, Paraguay

¹⁷. Department of Pediatric Intensive Care Unit, Hospital De Pediatric Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina

¹⁸. Emergency Department, National Children's Hospital “Dr. Carlos Saenz Herrera,” CCSS, San José, Costa Rica

¹⁹. Pediatric Intensive Care Unit, Fundación Valle del Lili, Cali, Valle del Cauca, Colombia

²⁰. Pediatric Critical Care Unit, Hospital De Ninos de La Plata Sor María Ludovica, Buenos Aires, Argentina

²¹. Pediatric Intensive Care Unit, Children's Hospital “Sor Maria Ludovica, Buenos Aires, Argentina, Pediatric Collaborative Latin American Network (LARed Network), Buenos Aires, Argentina

²². Hospital Civil de Guadalajara, Guadalajara, Mexico

²³. Pediatric Department, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China

²⁴. Department of Pediatrics, Pediatric Critical Care Division, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand

²⁵. Pediatric Critical Care Division, Department of Pediatrics, Ramathibodi Hospital, Bangkok, Thailand

²⁶. Pediatric Intensive Care Unit, Ricardo Guiterrez Children's Hospital, Buenos Aires, Argentina

²⁷. Pediatric Critical Care, Mexican Institute of Social Security, México City, Mexico

²⁸. Pediatrics Department, UKM Specialist Children's Hospital, Kuala Lumpur, Wilayah Persekutuan, Malaysia

²⁹. Department PICU, Hospital Universitario de Cruces, Barakaldo, Spain

³⁰. Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China

³¹. Department of Pediatrics, Sarawak General Hospital, Sarawak, Malaysia

³². Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China

³³. Pediatric Intensive Care Unit, General Hospital of Medellín “Luz Castro De Gutiérrez, Medellín, Colombia

³⁴. Pediatric Collaborative Latin American Network (LARed Network), Department of Pediatrics and Pediatric Intensive Care Unit, School of Medicine, Hospital Pereira Rossell, University of the Republic, Montevideo, Uruguay

³⁵. Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore

gmsljh@nus.edu.sg

syqian2020@163.com

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Abstract

Evidence for the use of prophylactic anti-seizure medication (ASM) in traumatic brain injury (TBI) in reducing the occurrence of early post-traumatic seizure (EPTS) remains equivocal. This study aimed to analyze the prevalence of EPTS in children with TBI, compare clinical characteristics of those with and without EPTS, and explore the association between prophylactic ASM and EPTS. We performed an observational study among 28 pediatric intensive care units in 15 countries from January 2014 to October 2022. The rate of EPTS was compared between individuals prescribed prophylactic ASM and those who were not. Logistic regression was used to examine the association between ASM and EPTS. Among 697 children with TBI, 161 (23.1%) developed EPTS and 280 (40.2%) received prophylactic ASM treatment. Use of prophylactic ASM was associated with a lower likelihood of developing EPTS (27/280 (9.6%) vs. 134/417 (32.1%), p < 0.001). The most frequently used prophylactic ASMs were phenytoin, levetiracetam, and phenobarbital. Age ≤ 4 years and GCS ≤ 8 were associated with increased odds of developing EPTS (aOR 2.29, 95% CI 1.54–3.40, p < 0.001 and aOR 1.80, 95% CI 1.18–2.74, p = 0.01). Our data provide evidence supporting the potential protective role of prophylactic ASM against EPTS.

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Jian Ji, Juan D. Roa G, Shu-Ling Chong, Quan Wang, Chin Seng Gan, Jane P. W. Ng, Thelma Elvira Teran Miranda, Freddy Israel Pantoja Chamorro, Lawrence Chi Ngong Chan, Qalab Abbas, Jacqueline S. M. Ong, Ivan J. Ardila, Yasser M. Kazzaz, Jesús A. Domínguez-Rojas, Hiroshi Kurosawa, Susana Beatriz Reyes Domínguez, Natalia Elizabeth Gómez Arriola, Natalia Zita Watzlawik, Adriana Yock-Corrales, Rubén Eduardo Lasso Palomino, Gabriela Aparicio, Paula Caporal, Rosa Elena de la Torre Gómez, Chunfeng Liu, Rujipat Samransamruajkit, Nattachai Anantasit, Deborah M. Turina, Marisol Fonseca Flores, Pei-Chuen Lee, Francisco J. Pilar-Orive, Hongxing Dang, Yek Kee Chor, Meixiu Ming, Juan C. Jaramillo-Bustamante, Sebastián González-Dambrauskas, Jan Hau Lee, Suyun Qian. Association Between Prophylactic Anti-Seizure Medication and Early Post-Traumatic Seizures: An International Observational Multicenter Study. MedComm, 2025, 6(12): e70524 DOI:10.1002/mco2.70524

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