What is the recommended duration for early seizure prophylaxis after moderate-severe TBI?

• A. Indefinitely
• B. Only during the acute hospital stay
• C. First 7 days
• D. Never

Answer: (C)

The key idea is that the goal of early seizure prophylaxis after moderate to severe TBI is to cover the brain during the high-risk window for early post-traumatic seizures, which is the first seven days after injury. Giving anticonvulsants during this initial week reduces the chance of seizures occurring soon after the trauma. Extending prophylaxis beyond seven days hasn’t shown added benefit in preventing those early seizures and adds unnecessary exposure to medication side effects and interactions. It also won’t reliably prevent late seizures or epilepsy that can develop later, so indefinite prophylaxis isn’t supported. Therefore, the recommended duration is the first seven days after injury.