Post-traumatic Epilepsies: Prophylactic Antiseizure Medications Are Futile

Objective: Post-traumatic epilepsy (PTE) is a significant sequela of traumatic brain injury (TBI), with a high incidence of drug-resistant epilepsy. The role of prophylactic antiseizure medications (ASM) remains controversial. This study investigates the demographic, clinical, radiological, and electrophysiological characteristics of PTE and evaluates the impact of ASM use. Methods: We retrospectively analyzed patients diagnosed with PTE at İstanbul University, İstanbul Faculty of Medicine Hospital (1994-2024). Clinical characteristics, imaging findings, electroencephalography results, and ASM use were assessed. Statistical analyses were conducted to explore correlations between trauma severity, epilepsy latency, and ASM efficacy. Results: There were 67 patients diagnosed with PTE, 73% of whom were male. Severe TBI (bone fracture, hemorrhage, or loss of consciousness >24 hours) was observed in 60% of patients. Bilateral magnetic resonance imagining (MRI) lesions were significantly associated with shorter epilepsy latency (p<0.01). Drug-resistant epilepsy was more common in severe TBI cases (p<0.03) and patients with longer periods of unconsciousness. ASM use did not influence epilepsy latency or seizure frequency. Three patients exhibited psychogenic non-epileptic seizures. Conclusion: ASM fails to prevent epileptogenesis and should not be routinely prescribed for seizure prophylaxis in patients with TBI. Trauma severity is a critical predictor of epilepsy onset and drug resistance. The presence of bilateral MRI lesions warrants closer monitoring. Given the complex consequences of TBI, these patients should be closely monitored by multidisciplinary teams.