Analyzing risk factors for late posttraumatic seizures: A prospective, multicenter investigation

Englander, Jeffrey; Bushnik, Tamara; Duong, Thao; Cifu, David X.; Zafonte, Ross; Wright, Jerry; Hughes, Richard L.; Bergman, William C.

doi:10.1053/apmr.2003.50022

Cited by 325 publications

(311 citation statements)

References 42 publications

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“…9,17,[20][21][22] Despite a decreasing risk of developing seizures and epilepsy over time, the risk persists for up to 10 years, which could be one explanation for the negative influence on long-term functional outcome. 4 Predictors of seizures in elderly patients were a low GCS score 24 hours after operation and a left-sided hematoma, similar to the previously published results by Rabinstein et al 21 Since elderly patients with comorbidities have clinical fluctuation more often than younger patients, the diagnosis of seizure may …”

Section: Discussionsupporting

confidence: 83%

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Won¹,

Dubinski²,

Brawanski³

et al. 2017

Neurosurgical Focus

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OBJECTIVEAcute subdural hematoma (aSDH) is a common disease increasing in prevalence given the demographic growth of the aging population. Yet, the benefit of surgical treatment for aSDH and the subsequent functional outcome in elderly patients (age ≥ 80 years) remain unclear. Therefore, the aims of this study were to evaluate the incidence of aSDH in patients 80 years or older, determine overall functional outcome, identify predictors of an unfavorable or favorable outcome, and establish specific risk factors for seizures.METHODSThe authors retrospectively analyzed patients 80 years and older who presented with isolated aSDH in the past 10 years at their institution. The following parameters were assessed: baseline characteristics, clinical status on admission and 24 hours after surgery, and clinical course. Functional outcome was assessed at discharge and the 3-month follow-up (FU).RESULTSIn the period from January 2007 to December 2016, 165 patients with aSDH were admitted to the authors’ institution. Sixty-eight patients (41.2%) were 80 years old or older, and the mean age overall was 85 years (range 80–96 years). The incidence of aSDH in the elderly had significantly increased over past decade, with more than 50% of patients admitted to our institution for aSDH now being 80 years or older. The overall mortality rate was 28% at discharge and 48% at the FU. Independent predictors of an unfavorable outcome at discharge were a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and pneumonia (p < 0.02). At the FU, a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and cumulative comorbidities (≥ 5; p < 0.05) were significant independent predictors. All patients with more than 6 comorbidities had died by the FU. Surgical treatment in comatose compared to noncomatose patients had statistically significant, higher mortality rates at discharge and the FU. Still, 23% of the comatose patients and more than 50% of the noncomatose patients had a favorable outcome at the FU (p = 0.06).CONCLUSIONSThe number of octo- and nonagenarians with aSDH significantly increased over the last decade. These patients can achieve a favorable outcome, especially those with a noncomatose status and fewer than 5 comorbidities. Surgical and nonsurgical treatment of octo- and nonagenarians during and after discharge should be optimized to increase clinical improvement.

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Section: Discussionsupporting

confidence: 83%

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Won¹,

Dubinski²,

Brawanski³

et al. 2017

Neurosurgical Focus

View full text Add to dashboard Cite

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“…The onset of seizures after TBI has been categorized into immediate (<24 hours after TBI), early (within a week after TBI), and late (>1 week after TBI) onset 5. Focal brain lesions in the frontal, temporal and parietal lobes, bilateral contusions, depressed fractures, midline shift >5 mm, subdural hematomas, decreased brain volume, intraparenchymal hemorrhage, and occurrence of seizures within the first week after TBI are important risk factors for PTE in humans 5, 6, 7, 8. Traumatic brain injury in dogs recently has been associated with significant risk of developing PTE with an incidence up to 6.8% 9, 10.…”

mentioning

confidence: 99%

Prognostic Value of Early Magnetic Resonance Imaging in Dogs after Traumatic Brain Injury: 50 Cases

Beltrán

Platt

McConnell

et al. 2014

Veterinary Internal Medicne

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BackgroundThe prognostic value of early magnetic resonance imaging (MRI) in dogs after traumatic brain injury (TBI) remains unclear.ObjectivesDetermine whether MRI findings are associated with prognosis after TBI in dogs.AnimalsFifty client‐owned dogs.MethodsRetrospective study of dogs with TBI that underwent 1.5T MRI within 14 days after head trauma. MRI evaluators were blinded to the clinical presentation, and all images were scored based on an MRI grading system (Grade I [normal brain parenchyma] to Grade VI [bilateral lesions affecting the brainstem with or without any lesions of lesser grade]). Skull fractures, percentage of intraparenchymal lesions, degree of midline shift, and type of brain herniation were evaluated. MGCS was assessed at presentation. The presence of seizures was recorded. Outcome was assessed at 48 h (alive or dead) and at 3, 6, 12, and 24 months after TBI.ResultsSixty‐six percent of the dogs had abnormal MRI findings. MRI grade was negatively correlated (P < .001) with MGCS. A significant negative correlation of MRI grade, degree of midline shift, and percentage of intraparenchymal lesions with follow‐up scores was identified. The MGCS was lower in dogs with brain herniation (P = .0191). Follow‐up scores were significantly lower in dogs that had brain herniation or skull fractures. The possibility of having seizures was associated with higher percentage of intraparenchymal lesions (P = 0.0054) and 10% developed PTE.Conclusions and Clinical ImportanceSignificant associations exist between MRI findings and prognosis in dogs with TBI. MRI can help to predict prognosis in dogs with TBI.

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“…Human studies have revealed that TBI is a major risk factor in the development of temporal lobe epilepsy (Englander et al, 2003). Hippocampal mossy fibers are composed of excitatory axons derived from DG granule cells, projecting to the CA3 region and forming part of the trisynaptic hippocampal circuit.…”

mentioning

confidence: 99%

Changes in TrkB–ERK1/2–CREB/Elk-1 Pathways in Hippocampal Mossy Fiber Organization after Traumatic Brain Injury

Liu

Bramlett

et al. 2004

J Cereb Blood Flow Metab

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Summary: Traumatic brain injury (TBI) leads to mossy fiber reorganization, which is considered to be a causative factor in the development of temporal lobe epilepsy. However, the underlying mechanism is not fully understood. Emerging evidence suggests that TrkB-ERK1/2-CREB/Elk-1 pathways are highly related to synaptic plasticity. This study used the rat fluid-percussion injury model to investigate activation of TrkB-ERK1/2-CREB/Elk-1 signaling pathways after TBI. Rats were subjected to 2.0-atm parasagittal TBI followed by 30 minutes, 4 hours, 24 hours, and 72 hours of recovery. After TBI, striking activation of TrkB-ERK1/2-CREB/Elk-1 signaling pathways in mossy fiber organization were observed with confocal microscopy and Western blot analysis. ERK1/2 was highly phosphorylated predominantly in hippocampal mossy fibers, whereas TrkB was phosphorylated both in the mossy fibers and the dentate gyrus region at 30 minutes and 4 hours of recovery after TBI. CREB was also activated at 30 minutes, peaked at 24 hours of recovery, and returned to the control level at 72 hours of recovery in dentate gyrus granule cells. Elk-1 phosphorylation was seen in CA3 neurons at 4 hours after TBI. The results suggest that the signaling pathways of TrkB-ERK1/2-CREB/Elk-1 are highly activated in mossy fiber organization, which may contribute to mossy fiber reorganization seen after TBI. Key Words: Traumatic brain injury-Mossy fiber-Seizure and epilepsy-Hippocampus-TrkB-ERK1/2-CREB/Elk-1.

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Analyzing risk factors for late posttraumatic seizures: A prospective, multicenter investigation

Cited by 325 publications

References 42 publications

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Prognostic Value of Early Magnetic Resonance Imaging in Dogs after Traumatic Brain Injury: 50 Cases

Changes in TrkB–ERK1/2–CREB/Elk-1 Pathways in Hippocampal Mossy Fiber Organization after Traumatic Brain Injury

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