Category: Professional Posters
Purpose: Posttraumatic seizure (PTS) is one of complications after traumatic brain injury (TBI), and up to 12% patients with severe TBI will develop PTS. In the 2017 “seizure prophylaxis in patients with TBI” guideline recommended that phenytoin or levetiracetam is effective in decreasing risk of early PTS in patients with severe TBI. The two studies from 1999 and 2000 recommended against use of valproate due to lack of benefit and the potentially higher mortality. In Wanfang hospital, valproate is often used for PTS prophylaxis. Our objective is to evaluate the effectiveness and safety of valproate in general and severe PTS patients.
Methods: This was a retrospective observational study. TBI patients were included between Jan, 2016 to Jun, 2017. Patients were excluded if they are pregnant, age less than 20, spinal injured, followed less than 7 days. Patients who had seizure before TBI prophylaxis, history of brain injure, and received cancer treatment 3 month prior to TBI event were also excluded. Baselines and outcomes including seizure rate, length of stay in ICU or hospital, functional outcome at the discharge from ICU or hospital, and in hospital mortality were compared between patients treated with valproate (VPA) and without valproate (No VPA). Side effects between VPA used> 7 days and < 7 days were also compared.
Results: There were 101 patients in VPA and 174 in No VPA group. There were no significant difference between VPA and No VPA group in terms of seizure rate (HR=1.15, CI=0.39-3.37), length of stay (ICU: HR=0.8, CI=-0.60-2.20; Hospital: HR=1.04, CI=-2.46-4.54), functional outcome (ICU: p=0.52; Hospital: p=0.42), and mortality (HR=1.03, CI=0.34-3.13). In patients with severe TBI, there were also no significant difference between VPA and No VPA groups in terms of seizure rate (HR=9.61, CI=0.83-111.32), length of stay (ICU: HR=1.26, CI=-8.79-11.30; Hospital: HR=-5.16, CI=-31.45-21.13), functional outcome (ICU: p=0.26; Hospital: p=0.72), and mortality (HR=0.72, CI=0.17-3.01).
Conclusion: Valproate does not reduce seizure rate or show additional benefit in general or severe group patients.