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

Sødal, Hild Flatmark; Storvig, Gøril; Tverdal, Cathrine; Robinson, Hilde Stendal; Helseth, Eirik; Taubøll, Erik

doi:10.1111/ane.13670

Cited by 9 publications

(11 citation statements)

References 40 publications

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“…In this study, alcohol abuse is a strong predictor of early PTS. This is consistent with studies from Norway [ 17 ], Southern Thailand [ 7 ], and the USA [ 14 ] which reported alcoholism as a strong risk factor for early PTS. This may be due to alcohol consumption may decrease seizure threshold by acting on gamma-aminobutyric acid receptors [ 17 , 25 ].…”

Section: Discussionsupporting

confidence: 91%

“…This study indicates that there is a high incidence of early PTS, which was observed in 17.7% of patients with moderate or severe TBI. This finding was higher than the report of previous studies conducted in the United States (1.9%) [ 16 ], Australia (2.7%) [ 9 ], Thailand (5.6%) [ 7 ], Italy (7%) [ 2 ], Shenzhen, China (2.8%) [ 18 ] and Norway (5.6%) [ 17 ], New Delhi, India(2.1%) [ 19 ], and Nigeria(10.1%) [ 21 ]. Likewise, a recent study based on a nationwide trauma database in the USA found that early seizures occurred in 0.4% of patients with TBI [ 14 ].…”

Section: Discussioncontrasting

confidence: 63%

“…is defined as at least one seizure observed or described by health care professionals occurring 24 h to 7 days after TBI [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

“…According to studies factors including age, TBI severity, medical comorbidities, subdural hemorrhage, epidural hematoma (EDH), brain contusion, and chronic alcohol abuse have been identified as predictors for early PTS [ 7 , 9 , 14 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Incidence and predictors of early posttraumatic seizures among patients with moderate or severe traumatic brain injury in Northwest Ethiopia: an institution-based prospective study

Baye,

Teshome

et al. 2024

BMC Neurol

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Background Early posttraumatic seizure (PTS) is a well-known complication of traumatic brain injury (TBI) that can induce the development of secondary brain injuries, including increased intracranial pressure, brain death, and metabolic crisis which may result in worse outcomes. It is also a well-recognized risk factor for the development of late post-traumatic seizure and epilepsy. This study was aimed to assess the incidence and predictors of PTS among patients with moderate or severe TBI admitted to Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia. Methods and setting An institutional-based prospective follow-up study was conducted on 402 patients with TBI admitted to the neurologic unit from June 1, 2022 to January 30, 2023. A systematic sampling technique was employed. The incidence rate of occurrence of early PTS was calculated. Both bivariable and multivariable Cox proportional hazard regression was performed. The strength of the association was measured using adjusted hazard ratios with a 95% confidence interval and p-values < 0.05. Results The incidence rate of early PTS was 2.7 per 100 person-days observation. Early PTS was observed in 17.7% of TBI patients. Age 75 and above (AHR = 2.85, 95%CI: 1.58–5.39), severe TBI (AHR = 2.06, 95%CI: 1.03–3.71), epidural hematoma (AHR = 2.4, 95% CI: 1.28–4.57), brain contusion (AHR = 2.6, 95%CI: 1.07–4.09), surgical intervention (AHR = 1.7, 95%CI: 1.03–3.82), posttraumatic amnesia (AHR = 1.99, 95%CI: 1.08–3.48), history of comorbidities (AHR = 1.56, 95%CI: 1.08–3.86), and history of alcohol abuse (AHR = 3.1, 95%CI: 1.89–5.23) were potential predictors of early PTS. Conclusion The incidence of early PTS was high. Since, early PTS can worsen secondary brain damage, knowing the predictors helps to provide an effective management plan for patients likely to develop early PTS and improve their outcome.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 63%

“…is defined as at least one seizure observed or described by health care professionals occurring 24 h to 7 days after TBI [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Incidence and predictors of early posttraumatic seizures among patients with moderate or severe traumatic brain injury in Northwest Ethiopia: an institution-based prospective study

Baye,

Teshome

et al. 2024

BMC Neurol

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“…2 Risk factors for early PTS include TBI severity, prior medical comorbidities, presence of subdural or subarachnoid hemorrhage, and alcohol abuse. [2][3][4] Early PTS are associated with poor long-term functional outcomes, late PTS and increased mortality. 3 The 2017 Brain Trauma Foundation's Guidelines for the Management of Severe TBI recommend the use of anticonvulsant prophylaxis (ACP) with phenytoin for the first 7 days post-injury to decrease the incidence of early PTS when the overall benefit is thought to outweigh the risk of complications.…”

Section: Introductionmentioning

confidence: 99%

Phenobarbital as Anticonvulsant Prophylaxis in Patients With Traumatic Brain Injury at Risk for Alcohol Withdrawal Syndrome

McGinnis

Wang

Chiappelli

et al. 2023

Journal of Pharmacy Practice

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Background: Anticonvulsant prophylaxis (ACP) for early post-traumatic seizures (PTS) is recommended in patients with traumatic brain injury (TBI). Phenobarbital (PB) may be used to prevent alcohol withdrawal syndrome (AWS) in at-risk patients. The dual-purpose use of PB in the TBI population would allow for consolidation of pharmacotherapy. Objective: The primary objective of this study was to determine the frequency of early PTS in TBI patients at risk of AWS treated with PB as ACP. Secondary objectives included determining rates of over sedation and endotracheal intubation. Methods: Patients received an intravenous (IV) loading dose of PB at 15-20 mg/kg followed by 1 mg/kg every 12 hours for 7 days with a goal level of 15-20 mcg/mL. Medication data, seizure frequency, and episodes of over sedation and endotracheal intubation were collected. Results: Eighty patients were treated with PB over a 1-year period. Thirty-nine patients were analyzed. Median loading dose was 19.9 (Interquartile Range 19.1-20.0) mg/kg with a median post load level of 21.7 mcg/mL (IQR 18.3-25.8) mcg/mL. One patient (2.6%) had electrographic evidence for early PTS. PB was discontinued in 4 (10.3%) patients out of concern for over sedation. One patient required endotracheal intubation after rapid PB loading. Conclusion: The frequency of early PTS was low when PB was used as primary ACP in patients with TBI at risk for AWS. Over sedation is a potential adverse effect that should be considered in the choice of ACP. No conclusions can be drawn as to the effectiveness of PB in preventing AWS.

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Which risk factors significantly influence the outcome of traumatic brain injured patients with alcohol use disorder?

Spille,

Kuroczik,

Görlich

et al. 2023

Eur J Trauma Emerg Surg

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Purpose Every year, approximately 10 million people worldwide suffer a traumatic brain injury that leads to hospitalization or mortality. Chronic and acute alcohol intoxication increase the risk of developing traumatic brain injury. Alcohol use disorder (AUD) as a predictor of outcome in neurosurgical patients and the definition of risk factors have been sparsely addressed so far. This study aims to improve the understanding of the effects of alcohol use disorder in the context of neurosurgical therapy. Methods This study included patients admitted to Münster University Hospital with a traumatic brain injury and alcohol use disorder from January 1, 2010, to December 31, 2018. Univariate and multivariate analyses were performed to identify risk factors for a poorer outcome, assessed by the Glasgow Outcome Score. Results Of the 197 patients included, 156 (79%) were male, and 41 (21%) were female, with a median age of 49 years (IQR 38–58 years). In multivariate analyses, age (p < 0.001), the occurrence of a new neurologic deficit (p < 0.001), the development of hydrocephalus (p = 0.005), and CT-graphic midline shift due to intracerebral hemorrhage (p = 0.008) emerged as significant predictors of a worse outcome (GOS 1–3). In addition, the level of blood alcohol concentration correlated significantly with the occurrence of seizures (p = 0.009). Conclusions Early identification of risk factors in patients with alcohol use disorder and traumatic brain injury is crucial to improve the outcome. In this regard, the occurrence of hydrocephalus or seizures during the inpatient stay should be considered as cause of neurological deterioration in this patient group.

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

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 9 publications

References 40 publications

Incidence and predictors of early posttraumatic seizures among patients with moderate or severe traumatic brain injury in Northwest Ethiopia: an institution-based prospective study

Incidence and predictors of early posttraumatic seizures among patients with moderate or severe traumatic brain injury in Northwest Ethiopia: an institution-based prospective study

Phenobarbital as Anticonvulsant Prophylaxis in Patients With Traumatic Brain Injury at Risk for Alcohol Withdrawal Syndrome

Which risk factors significantly influence the outcome of traumatic brain injured patients with alcohol use disorder?

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