Most patients who had an early seizure dropped out and were offered antiepileptic medication. In 1 study using phenobarbital, poor compliance was associated with increased risk for seizures, perhaps explained by a reduced seizure threshold during acute withdrawal. In another study, however, first seizures were not associated with low drug levels. I recommend that phenytoin be given within a few hours of a serious head injury, particularly if risk factors exist for seizures. It should be continued for a few weeks and then slowly withdrawn if no seizures occur.
Good compliance is essential.
Family doctors need to know that phenytoin should not be prescribed indefinitely. But whether any value can be found in continuing antiepileptic medication to prevent late seizures in patients who have had an early seizure is not known. Simon Fleminger, MB, PhD Maudsley Hospital London, England, UK Reference 1.