2023 American Academy of Neurology Abstract Website

Objective:

To determine antiseizure medication (ASM) prescription patterns and association with outcomes in older adults with traumatic brain injury (TBI).

Background:

TBI in older adults is a public health concern and priority. Older adults have higher rates of TBI and post-injury complications including seizures. While current guidelines support the use of prophylactic ASMs for up to 7 days after severe TBI, the effectiveness of ASM use in older adults is yet to be determined resulting in practice variation. Older adults are also at highest risk for ASM adverse effects.

Design/Methods:

This is a retrospective study of older adults (>65 years) admitted to a single center for ≥7 days following an acute TBI. The primary exposure was prophylactic ASM administration ≤ 7 (as supported by guidelines) vs >7 days. The primary outcome was death/severe disability at discharge (modified Rankin Scale of 5-6).

Results:

188 patients were included. Median age was 82 years; 46% were female. Fall (90%) was the most common cause of TBI, followed by motor vehicle accidents (7%) and other causes (2%). 21 patients (11%) had clinical seizures on admission. 43 (23%) had dementia or cognitive concerns prior to admission. 13/94 (13%) patients that underwent electroencephalography monitoring had electrographic seizures. 52% received ASM for ≤ 7 days, 41% for > 7 days, and 7% received no ASMs. Levetiracetam was the only ASM prescribed. After adjusting for TBI severity, Charlson Comorbidity Index, seizures, and imaging findings, ASM administration for >7 days (compared with ≤7 days) although had higher odds of death/severe disability at discharge, the finding did not reach statistical significance (adjusted OR = 2.0 [95% CI 0.55-7.13]).

Conclusions:

ASMs were frequently continued for >7 days with no significant association with short-term outcomes. Larger comparative studies are indicated to determine both short and long-term risk-benefit trade-offs of ASM prophylaxis in older adults with TBI.