2026 Southeastern Residency Conference

Background: Traumatic brain injury (TBI) is associated with increased risk of post-traumatic seizures (PTS), and seizure prophylaxis may reduce seizure prevalence, brain injury, and mortality.1,2 Currently, guidelines from the American College of Surgeons Trauma Quality Programs (ACS-TQIP), Brain Trauma Foundation (BTF), and Neurocritical Care Society (NCS) recommend the use of levetiracetam or phenytoin for early PTS prevention in patients with TBIs.1,3,4 However, adverse effects associated with levetiracetam, including somnolence and behavioral disturbances (i.e. agitation, hallucinations, emotional lability), have prompted interest in lacosamide as a potential alternative. 5 Levetiracetam is the standard antiepileptic medication prescribed for PTS prophylaxis at Prisma Health Richland. This study will evaluate the efficacy and safety of lacosamide compared with levetiracetam for seizure prophylaxis in patients with TBI.
Methods: Adults diagnosed with TBI and, within 24 hours of admission, received seizure prophylaxis with either lacosamide or levetiracetam between February 27th, 2021, and August 31st, 2025, were included in the study. Patients were excluded if they had a history of seizures or epilepsy prior to admission or if they had a seizure prior to initiating antiepileptic medication. The primary objective, seizure incidence within the first 7 days following TBI, will be analyzed using multivariable logistic regression adjusting for clinically relevant covariates and incorporating propensity score methods as appropriate. Secondary objectives include time to seizure following prophylaxis initiation, analyzed using Cox proportional hazards regression, and adverse effects occurring within 7 days of prophylaxis initiation, which will be summarized descriptively and compared using appropriate statistical tests.
Results: In Progress
Conclusions: In Progress