Association of Posttraumatic Epilepsy With 1-Year Outcomes After Traumatic Brain Injury

Abstract

IMPORTANCEPosttraumatic epilepsy (PTE) is a recognized sequela of traumatic brain injury (TBI), but the long-term outcomes associated with PTE independent of injury severity are not precisely known. OBJECTIVE To determine the incidence, risk factors, and association with functional outcomes and self-reported somatic, cognitive, and psychological concerns of self-reported PTE in a large, prospectively collected TBI cohort. DESIGN, SETTING, AND PARTICIPANTS This multicenter, prospective cohort study was conducted as part of the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study and identified patients presenting with TBI to 1 of 18 participating level 1 US trauma centers from February 2014 to July 2018. Patients with TBI, extracranial orthopedic injuries (orthopedic controls), and individuals without reported injuries (eg, friends and family of participants; hereafter friend controls) were prospectively followed for 12 months. Data were analyzed from January 2020 to April 2021. EXPOSURE Demographic, imaging, and clinical information was collected according to TBI Common Data Elements. Incidence of self-reported PTE was assessed using the National Institute of Neurological Disorders and Stroke Epilepsy Screening Questionnaire (NINDS-ESQ). MAIN OUTCOMES AND MEASURES Primary outcomes included Glasgow Outcome Scale Extended, Rivermead Cognitive Metric (RCM; derived from the Rivermead Post Concussion Symptoms Questionnaire), and the Brief Symptom Inventory-18 (BSI). RESULTS Of 3296 participants identified as part of the study, 3044 met inclusion criteria, and 1885 participants (mean [SD] age, 41.3 [17.1] years; 1241 [65.8%] men and 644 [34.2%] women) had follow-up information at 12 months, including 1493 patients with TBI; 182 orthopedic controls, 210 uninjured friend controls; 41 patients with TBI (2.8%) and no controls had positive screening resultsfor PTE. Compared with a negative screening result for PTE, having a positive screening result for PTE was associated with presenting Glasgow Coma Scale score (8.1 [4.8] vs.13.5 [3.3]; P < .001) as well as with anomalous acute head imaging findings (risk ratio, 6.42 [95% CI,). After controlling for age, initial Glasgow Coma Scale score, and imaging findings, compared with patients with TBI and without PTE, patients with TBI and with positive PTE screening results had significantly lower Glasgow Outcome Scale Extended scores (mean [SD], 6.1 [1.7] vs 4.7 [1.5]; P < .001), higher BSI scores (mean [SD], 50.

Early post‐traumatic seizures in hospitalized patients with traumatic brain injury

“…Traumatic brain injury (TBI) is a major health problem and can have a decisive impact on functional capacity and quality of life 1,2 . Epileptic seizures are a common complicatio that adds an additional burden to the challenges of TBI 3,4 . Onset of post‐traumatic seizures varies from seconds to several years after brain injury.…”

“…1 , 2 Epileptic seizures are a common complicatio that adds an additional burden to the challenges of TBI. 3 , 4 Onset of post‐traumatic seizures varies from seconds to several years after brain injury. Early post‐traumatic seizures (EPTS) are usually defined as seizures occurring within the first 7 days after injury.…”

Tinjauan atas Epilepsi Pasca-Trauma Kapitis

“…7 PENDEKATAN DIAGNOSIS Definisi operasional epilepsi menurut ILAE 2014, yaitu: (1) Minimal terdapat dua bangkitan tanpa provokasi atau dua bangkitan refleks dengan jarak waktu antar bangkitan pertama dan kedua lebih dari 24 jam; (2) Satu bangkitan tanpa provokasi atau bangkitan refleks dengan kemungkinan terjadinya bangkitan berulang dalam 10 tahun ke depan sama dengan bila terdapat 2 bangkitan tanpa provokasi atau bangkitan refleks; (3) Diagnosis sindrom epilepsi sudah ditegakkan. 21 Diagnosis epilepsi pasca-trauma kapitis dapat ditegakkan terutama dari anamnesis didukung pemeriksaan fisik dan penunjang. Perlu digali riwayat cedera kepala, dan tanda-tanda neurologis fokal atau difus yang berhubungan dengan bangkitan.…”

Pre-existing Toxoplasma gondii infection increases susceptibility to pentylenetetrazol-induced seizures independent of traumatic brain injury in mice

“…PTE accounts for 10–20% of acquired epilepsy in the general population and it is reported that between 4 and 50% of individuals with TBI develop PTE ( Degrauw et al, 2018 ; Tubi et al, 2019 ; Pease et al, 2022 ). PTE diagnosis is also associated with heightened morbidity and mortality ( Burke et al, 2021 ; Karlander et al, 2022 ; Ngadimon et al, 2022 ).…”