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 will change the anti-seizure medication, often to valproate (due to mood stabilizing effects). I suspect that patients with bilateral orbitofrontal contusions are most susceptible to severe agitation and are most likely to benefit from a medication other than levetiracetam.