Late Post-traumatic Epilepsy in Children and Young Adults: Impropriety of Long-Term Antiepileptic Prophylaxis and Risks in Tapering

Strazzer, Sandra; Pozzi, Marco; Avantaggiato, Paolo; Zanotta, Nicoletta; Epifanio, Roberta; Beretta, Elena; Formica, Francesca; Locatelli, Federica; Galbiati, Sara; Clementi, Emilio; Zucca, Claudio

doi:10.1007/s40272-016-0167-3

Cited by 7 publications

(1 citation statement)

References 35 publications

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“…Although the exact pathogenesis of PTE remains still unknown, a relationship between dysfunction of blood-brain barrier (BBB) following TBI and epilepsy has also been documented, both in animal and human studies [33]. Our results, in agreement with other clinical studies, show that there is no association between the occurrence of seizures and the severity of TBI within 6 months [34][35][36]. The main reason for this lack of association lies in the etiopathogenesis of post-traumatic seizures.…”

Section: Discussionsupporting

confidence: 79%

Thyroid function in the subacute phase of traumatic brain injury: a potential predictor of post-traumatic neurological and functional outcomes

Mele

Pagano

Franciotta

et al. 2021

J Endocrinol Invest

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Purpose That thyroid hormones exert pleiotropic effects and have a contributory role in triggering seizures in patients with traumatic brain injury (TBI) can be hypothesized. We aimed at investigating thyroid function tests as prognostic factors of the development of seizures and of functional outcome in TBI. Methods This retrospective study enrolled 243 adult patients with a diagnosis of mild-to-severe TBI, consecutively admitted to our rehabilitation unit for a 6-month neurorehabilitation program. Data on occurrence of seizures, brain imaging, injury characteristics, associated neurosurgical procedures, neurologic and functional assessments, and death during hospitalization were collected at baseline, during the workup and on discharge. Thyroid function tests (serum TSH, fT4, and fT3 levels) were performed upon admission to neurorehabilitation. Results Serum fT3 levels were positively associated with an increased risk of late post-traumatic seizures (LPTS) in post-TBI patients independent of age, sex and TBI severity (OR = 1.85, CI 95% 1.22–2.61, p < 0.01). Measured at admission, fT3 values higher than 2.76 pg/mL discriminated patients with late post-traumatic seizures from those without, with a sensitivity of 74.2% and a specificity of 60.9%. Independently from the presence of post-traumatic epilepsy and TBI severity, increasing TSH levels and decreasing fT3 levels were associated with worse neurological and functional outcome, as well as with higher risk of mortality within 6 months from the TBI event. Conclusions Serum fT3 levels assessed in the subacute phase post-TBI are associated with neurological and functional outcome as well as with the risk of seizure occurrence. Further studies are needed to investigate the mechanisms underlying these associations.

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