There are three periods in which patients with TBI are susceptible to seizures: acute, early, and late. Acute seizures occur within minutes of the head injury; early seizures occur within one week of head injury; late seizures occur after one week of head injury. Acute seizures are associated with a high mortality from expanding hematomas. However, if the patient survives, the situation is the least likely to be associated with a long-term seizure disorder. Late seizures are most likely to result in a prolonged seizure disorder. Seizures are four times more common following penetrating trauma than blunt trauma.

Because seizures result in hypoxia, increased cerebral ischemia, and increased ICP, the use of anticonvulsants, such as phenytoin, is recommended for all patients with severe TBI for one week after the injury. Indications include patients with intracranial hemorrhage or hematoma, depressed skull fractures or penetrating injuries, a posttraumatic seizure or any patients who are paralyzed. Long-term use of anticonvulsants has not been shown to decrease incidence of seizures beyond one week.28 If the patient is no longer paralyzed, and not had a breakthrough seizure for one week, the anticonvulsant can be discontinued.

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