Prophylactic and Preventive Use of Antiepileptic Drugs

Physicians occasionally administer antiepileptic drugs (AEDs) to patients liable to have generalized tonic-clonic seizures (GTCSs), but not known to have epilepsy, with the intent to prevent a convulsive seizure. Likelihood to develop posttraumatic epilepsy (PTE) appears to correlate with the severity of head injury. Classification of head injury based upon clinical evidence of trauma dose shows a correlation with epilepsy risk. Clinical experiments reporting efficacy of AEDs in the prevention of the development of PTE appeared within a few years of the availability of phenytoin. Variations in design included open, retrospective, or prospective studies that may have had, as additional features, patient or investigator blinding, placebo control, or use of historical controls. Patients with primary generalized epilepsy manifested exclusively by absences may develop GTCSs as an additional manifestation of their epilepsy. Prevention of seizures could be considered for patients with cerebral infarction.