Perbandingan Efektivitas Asam Valproat dengan Fenobarbital dalam Mencegah Kejang Pascatrauma Lanjut pada Pasien Cedera Kepala

Abstract

Background:Late post-traumatic seizures (LPTS) are a significant complication of traumatic brain injury (TBI). The comparative effectiveness of valproic acid (VPA) and phenobarbital (PB) for LPTS prevention remains uncertain. The aim of this study is to compare the efficacy of VPA versus PB in preventing LPTS in TBI patients. Methods: A systematic review and meta-analysis were conducted using PRISMA 2020 guidelines. Seven studies (5 RCTs, 2 cohorts) were analyzed. Quality assessment used the Jadad Scale and Newcastle–Ottawa Scale. A random-effects model was applied. Results: Twelve studies (7 RCTs, 5 cohort) involving 1,027 patients met the inclusion criteria. VPA significantly reduced the risk of LPTS compared to PB (OR: 0.46; 95% CI: 0.31–0.67; p < 0.0001), with moderate heterogeneity (I² = 42%). Results remained stable in sensitivity analysis. Conclusion: Valproic acid is more effective than phenobarbital in preventing LPTS and may be preferred, especially in resource-limited settings. Further studies are needed to confirm long-term outcomes.