Clinical analysis on risk factors and prognosis of early post-traumatic epilepsy

Liu, Zaiming; Chen, Qianxue; Wang, Junmin; Tian, Daofeng; Wang, Long; Liu, Baohui; Zhang, Shenqi

doi:10.1590/0004-282x20190071

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…Early posttraumatic seizures (EPS) occur during the acute phase following a traumatic brain injury (TBI). The incidence of EPS varies, depending on the population and EPS definition, from 0.4% to 10.5% . These EPS have been associated with greater morbidity and mortality …”

Section: Introductionmentioning

confidence: 99%

Risk Factors and Prognosis of Early Posttraumatic Seizures in Moderate to Severe Traumatic Brain Injury

et al. 2022

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IMPORTANCEEarly posttraumatic seizures (EPS) that may occur following a traumatic brain injury (TBI) are associated with poorer outcomes and development of posttraumatic epilepsy (PTE).OBJECTIVE To evaluate risk factors for EPS, associated morbidity and mortality, and contribution to PTE.DESIGN, SETTING, AND PARTICIPANTS Data were collected from an Australian registry-based cohort study of adults (age Ն18 years) with moderate to severe TBI from January 2005 to December 2019, with 2-year follow-up. The statewide trauma registry, conducted on an opt-out basis in Victoria (population 6.5 million), had 15 152 patients with moderate to severe TBI identified via Abbreviated Injury Scale (AIS) head severity score, with an opt-out rate less than 0.5% (opt-out n = 136).MAIN OUTCOMES AND MEASURES EPS were identified via International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes recorded after the acute admission. Outcome measures also included in-hospital metrics, 2-year outcomes including PTE, and post-discharge mortality. Adaptive least absolute shrinkage and selection operator (LASSO) regression was used to build a prediction model for risk factors of EPS. RESULTS Among the 15 152 participants (10 457 [69%] male; median [IQR] age, 60 [35-79] y), 416 (2.7%) were identified with EPS, including 27 (0.2%) with status epilepticus. Significant risk factors on multivariable analysis for developing EPS were younger age, higher Charlson Comorbidity Index, TBI sustained from a low fall, subdural hemorrhage, subarachnoid hemorrhage, higher Injury Severity Score, and greater head injury severity, measured using the AIS and Glasgow Coma Score. After adjustment for confounders, EPS were associated with increased ICU admission and ICU length of stay, ventilation and duration, hospital length of stay, and discharge to inpatient rehabilitation rather than home, but not in-hospital mortality. Outcomes in TBI admission survivors at 24 months, including mortality (relative risk [RR] = 2.14; 95% CI, 1.32-3.46; P = .002), development of PTE (RR = 2.91; 95% CI, 2.22-3.81; P < .001), and use of antiseizure medications (RR = 2.44; 95% CI, 1.98-3.02; P < .001), were poorer for cases with EPS after adjustment for confounders. The prediction model for EPS had an area under the receiver operating characteristic curve of 0.72 (95% CI, 0.66-0.79), sensitivity of 66%, and specificity of 73% in the validation set.DISCUSSION We identified important risk factors for EPS following moderate to severe TBI. Early posttraumatic seizures were associated with longer ICU and hospital admissions, ICU ventilation, and poorer 24-month outcomes including mortality and development of PTE.

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Section: Introductionmentioning

confidence: 99%

Risk Factors and Prognosis of Early Posttraumatic Seizures in Moderate to Severe Traumatic Brain Injury

et al. 2022

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“…Zaiming Liu et al [120] conducted a clinical analysis focusing on prognosis and risk factors associated with early Post-Traumatic Epilepsy (EPTE) following TBI. The study analyzed data from 186 patients, identifying crucial risk factors that influence the development of EPTE.…”

Section: Post-traumatic Epilepsy Risk Factorsmentioning

confidence: 99%

Epidemiology, Risk Factors, and Biomarkers of Post-Traumatic Epilepsy: A Comprehensive Overview

Kazis,

Chatzikonstantinou,

Ciobica

et al. 2024

Biomedicines

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This paper presents an in-depth exploration of Post-Traumatic Epilepsy (PTE), a complex neurological disorder following traumatic brain injury (TBI), characterized by recurrent, unprovoked seizures. With TBI being a global health concern, understanding PTE is crucial for effective diagnosis, management, and prognosis. This study aims to provide a comprehensive overview of the epidemiology, risk factors, and emerging biomarkers of PTE, thereby informing clinical practice and guiding future research. The epidemiological aspect of the study reveals PTE as a significant contributor to acquired epilepsies, with varying incidence influenced by injury severity, age, and intracranial pathologies. The paper delves into the multifactorial nature of PTE risk factors, encompassing clinical, demographic, and genetic elements. Key insights include the association of injury severity, intracranial hemorrhages, and early seizures with increased PTE risk, and the roles of age, gender, and genetic predispositions. Advancements in neuroimaging, electroencephalography, and molecular biology are presented, highlighting their roles in identifying potential PTE biomarkers. These biomarkers, ranging from radiological signs to electroencephalography EEG patterns and molecular indicators, hold promise for enhancing PTE pathogenesis understanding, early diagnosis, and therapeutic guidance. The paper also discusses the critical roles of astrocytes and microglia in PTE, emphasizing the significance of neuroinflammation in PTE development. The insights from this review suggest potential therapeutic targets in neuroinflammation pathways. In conclusion, this paper synthesizes current knowledge in the field, emphasizing the need for continued research and a multidisciplinary approach to effectively manage PTE. Future research directions include longitudinal studies for a better understanding of TBI and PTE outcomes, and the development of targeted interventions based on individualized risk profiles. This research contributes significantly to the broader understanding of epilepsy and TBI.

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“…Temporal trauma results in synaptic disruption in the hippocampus, a region associated with epileptic seizures 1 . In addition, Liu et al confirm that open cranial trauma is more strongly associated with early epileptic seizures post trauma than closed trauma 8 . Accidents with severe brain damage are much more likely to be associated with abnormal cortical neuronal discharges, possibly leading to epilepsy, than milder accidents 1 .…”

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confidence: 98%

“…In this issue of the journal, Liu et al report on risk factors and prognosis related to early epileptic seizures after trauma (EPTE) 8 . This is important as it may increases further the risk of PTE over the years.…”

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confidence: 99%

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Post traumatic epilepsy: there is still much to learn

Mendonça

Sander

2019

Arq. Neuro-Psiquiatr.

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T raumatic brain injury (TBI) is one of the most common causes of death and motor disability mainly in people under the age of 40 years but also in senior citizens 1 . TBI numbers have steadily increased over the years and have now reached epidemic proportions 1,2 . This, however, is not well recognised and TBI has recently been described as the silent or hidden epidemic 1 . In addition to high mortality, TBI produces hardship on individuals and their families as well as being a major societal burden. TBI when not fatal often leads to the incapacity of young people which directly generates public health expenditure and, over a life time, incurs major indirect costs particularly in terms of social benefits 1,2,3,4 .Epidemiological data on TBI vary throughout the world in terms of demographics and causality. Recent data suggest a first incidence peak between the ages of 20 and 30 years and a second peak in those over 60 years old 3,4 . Common causes include road traffic accidents, violence, falls, occupational hazards in the building and farming industries, domestic accidents and contact sports 1,3,4 . Alcohol overindulgence seems to be a major risk factor 3 . The incidence of TBI seems to correlate with social development and the poorer the country the greater the number of fatal accidents. A recent development seems to be that the rapid deployment of two-wheeled vehicles in some resource-poor settings has led to local epidemics of TBI 1 . In view of the most common causes, it is not surprising that TBI is much more frequent in males 1,3 .An increase in the prevalence of acute symptomatic epileptic seizures has been observed recently, with TBI being one of the main causes 4,5 . Studies have already confirmed that central nervous system injuries such as ischemic or haemorrhagic stroke, cerebral anoxia, brain infection, brain inflammation, autoimmune diseases and degenerative diseases are all associated with evolution to epileptic seizures either acute seizures but also late seizures 3,4 . By definition TBI is the only direct risk factor for Post-Traumatic Epilepsy (PTE) and this risk is well known. One of the many outstanding issues is, however, if acute or early seizures are enhancers of the risk and by which factor.The definitions for post-trauma seizures usually used are: immediate (occurring within 24 hours), early (within the first 7 days) and late (occurring after 7 days). According to the International League Against Epilepsy (ILAE) an isolated late unprovoked seizure associated with a known traumatic brain injury now fulfils the criteria for epilepsy 6,7 . Using this new definitions some case series have established an 80% risk of seizure recurrence over the two initial years following cranial trauma with a late post-traumatic seizure 6 although not all of these recur to conform to the old definition of epilepsy (of two unprovoked epileptic seizures at least 24 hours apart). Overall epidemiological data suggest that the risk is higher in the first 6 months, but remains increased for up to 10 years. There se...

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Clinical analysis on risk factors and prognosis of early post-traumatic epilepsy

Cited by 5 publications

References 22 publications

Risk Factors and Prognosis of Early Posttraumatic Seizures in Moderate to Severe Traumatic Brain Injury

Risk Factors and Prognosis of Early Posttraumatic Seizures in Moderate to Severe Traumatic Brain Injury

Epidemiology, Risk Factors, and Biomarkers of Post-Traumatic Epilepsy: A Comprehensive Overview

Post traumatic epilepsy: there is still much to learn

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