Which anticonvulsant is indicated for seizures in head trauma?

• A. Valium
• B. Dilantin
• C. Keppra
• D. Ativan

Answer: (B)

In head trauma, preventing early post-traumatic seizures is a key goal, since seizures can worsen brain injury. Phenytoin (Dilantin) has long been used for this purpose because it stabilizes neuronal membranes by blocking voltage-gated sodium channels, reducing the likelihood of the sudden bursts of electrical activity that cause seizures. It’s typically given for short-term prophylaxis after head injury, often for about a week.

Benzodiazepines like diazepam (Valium) and lorazepam (Ativan) are excellent for stopping an active seizure, but they’re not ideal for ongoing prophylaxis due to sedation, tolerance, and other side effects. Levetiracetam (Keppra) is another option used today and has a favorable side-effect profile, but the traditional choice specific to head trauma prophylaxis has been phenytoin.