What is the role of prophylactic anticonvulsants in the immediate period after moderate-severe TBI?

• A. Never used.
• B. Always continued long-term regardless of seizures.
• C. Use only after seizures occur.
• D. Often used for early seizure prophylaxis (first 7 days) in high-risk patients; not routinely continued long-term without seizures.

Answer: (D)

Early post-traumatic seizures are most likely in the first week after a moderate-to-severe TBI. Prophylactic anticonvulsants are used to prevent those early seizures, but only for a short, defined period in patients at high risk. The standard approach is to give a short course—about seven days—during which the risk of early seizures is highest. If no seizures occur, the medication is typically stopped because evidence does not show a benefit for preventing later epilepsy with long-term prophylaxis, and continuing it long-term adds unnecessary risk of side effects and drug interactions. If seizures do occur, treatment is adjusted based on the new clinical course, but the routine practice is not to maintain long-term prophylaxis in the absence of seizures.