Would you avoid the use of keppra in patients with TBI due to concerns for worsening agitation?  

I suspect that this practice of prophylactic antiepileptic medications for TBI patients will go away over time. History has shown us time and time again that we over-medicate patients.

I think this is a judgment call. My personal practice (and the practice at my institution) is to use levetiracetam for one week to minimize the risk of early post-traumatic seizures and to use levetiracetam to treat early post-traumatic seizures. If the patient develops severe agitation, then we wil...