• Zachary L Hickman, Lisa A Spielman, Ernest J Barthélemy, Tanvir F Choudhri, Brittany Engelman, Al O Giwa, Jacob D Greisman, Konstantinos Margetis, Meaghan Race, Jueria Rahman, D Roxanne Todor, Spyridoula Tsetsou, Jamie S Ullman, Prashin Unadkat, and Kristen Dams-O'Connor.
• Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York New York Neurotrauma Consortium (NYNC), LLC, New York, New York, USA.
• World Neurosurg. 2022 Dec 1; 168: e286e296e286-e296.

BackgroundSeizures and epilepsy after traumatic brain injury (TBI) negatively affect quality of life and longevity. Antiseizure medication (ASM) prophylaxis after severe TBI is associated with improved outcomes; these medications are rarely used in mild TBI. However, a paucity of research is available to inform ASM use in complicated mild TBI (cmTBI) and no empirically based clinical care guidelines for ASM use in cmTBI exist. We aim to identify seizure prevention and management strategies used by clinicians experienced in treating patients with cmTBI to characterize standard care and inform a systematic approach to clinical decision making regarding ASM prophylaxis.MethodsWe recruited a multidisciplinary international cohort through professional organizational listservs and social media platforms. Our questionnaire assessed factors influencing ASM prophylaxis after cmTBI at the individual, institutional, and health system-wide levels.ResultsNinety-two providers with experience managing cmTBI completed the survey. We found a striking diversity of ASM use in cmTBI, with 30% of respondents reporting no/infrequent use and 42% reporting frequent use; these tendencies did not differ by provider or institutional characteristics. Certain conditions universally increased or decreased the likelihood of ASM use and represent consensus. Based on survey results, ASMs are commonly used in patients with cmTBI who experience acute secondary seizure or select positive neuroimaging findings; we advise caution in elderly patients and those with concomitant neuropsychiatric illness.ConclusionsThis study is the first to characterize factors influencing clinical decision making in ASM prophylaxis after cmTBI based on multidisciplinary multicenter provider practices. Prospective controlled studies are necessary to inform standardized guideline development.Copyright © 2022 Elsevier Inc. All rights reserved.

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