Do you remember when Antiepileptics, used for seizure prophylaxis after traumatic brain injury (TBI), were being prescribed for months on end? Do you also remember some treating doctors (for work comp injuries) issuing seemingly endless “off work status” due to associated risk? Well, those days are gone.
According to guidelines issued by the Brain Trauma Foundation and the American Academy of Neurology (AAN) for the management of severe TBI, PTS prophylaxis is recommended only during the first seven days after TBI. Best medication: of the available antiepileptic drugs, phenytoin has been the most extensively studied for the prophylaxis of PTS. Phenobarbital, valproate, and carbamazepine have not been as extensively researched, and, given their adverse-effect profiles and pharmacodynamic properties, there is no advantage to using these agents over phenytoin.
Keeping current is a must, not all clinics and physician keep up with these changes so the carrier must be able to flag treatment, prophylaxis being a big one. Nurse case managers are here to help make sure patients are getting the most current, effect treatment while removing barriers to return to work.
Reference: Resource: Critical Care, Brigham and Women’s Hospital, Boston, MA 02115.