Prophylactic anti-seizure medication for post-traumatic seizures in Chinese PICUs: current practices and knowledge gaps

To evaluate current practices and asses knowledge gaps in the use of prophylactic anti-seizure medication (ASM) for managing pediatric post-traumatic epilepsy (PTE) in Mainland China, with a particular focus on clinical decision-making of pediatric intensive care unit (PICU) physicians.

A nationwide cross-sectional survey of 271 physicians across 30 tertiary hospital PICUs in 23 provinces was conducted between December 2023 and March 2024. The questionnaire assessed ASM utilization, treatment selection and duration, management of adverse events, and awareness of PTE risk factors. Descriptive statistics were used for data analysis.

Among the surveyed physicians, 72.7% reported prescribing prophylactic ASM, with levetiracetam (52.3%), phenobarbital (23.4%), and sodium valproate (22.3%) being the most common. The duration of treatment varied considerably: 29.4% of physicians continued prophylactic ASM up to 3 months following traumatic brain injury, whereas 22.3% of them limited the course to ≤ 7 days. Routine electroencephalogram monitoring was conducted by 78.7% of physicians. Common adverse events, including hepatotoxicity, rashes, and cognitive effects, were reported by 40.6% of the physicians. Notably, 85% of physicians continued ASM despite observing these complications. Hence, substantial knowledge gaps exist, particularly regarding the criteria for discontinuing ASM.

Significant variability exists in prophylactic ASM practices across PICUs in China, influenced by inconsistent adherence to guidelines, physician experience, and interdisciplinary collaborations. These findings highlight the urgent need to develop standardized protocols and conduct evidence-based training to optimize PTE prevention. Further research is warranted to device individualized ASM regimens tailored to the severity of the injury, age of the patients, and neurodevelopmental outcomes.