Prognostic factors in the occurrence of posttraumatic epilepsy after penetrating head injury suffered during military service

Abstract

<jats:p>In this retrospective study, the authors evaluated confounding risk factors, which are allegedly influential in causing unprovoked posttraumatic epilepsy, in 489 patients from the frontlines of the Iran–Iraq War.</jats:p> <jats:p>Four hundred eighty-nine patients were followed for 6 to154 months (mean 39.4 months, median 23 months), and important factors precipitating posttraumatic epilepsy were evaluated using uni- and multivariate regression analysis.</jats:p> <jats:p>One hundred fifty-seven (32%) of 489 patients became epileptic during the study period. The results of univariate analysis indicated a significant relationship between epilepsy and Glasgow Outcome Scale (GOS) score (X<jats:sup>2</jats:sup> = 76.49, p &lt; 0.0001, df = 2), Glasgow Coma Scale score at admission (X<jats:sup>2</jats:sup> = 19.48, p &lt; 0.0001, df = 3), motor deficit (X<jats:sup>2</jats:sup> = 11.79, p &lt; 0.001, df = 1), mode of injury (X<jats:sup>2</jats:sup> = 10.731, p &lt; 0.05), transventricular injury (X<jats:sup>2</jats:sup> = 6.9, p &lt; 0.008, df = 1), dysphasia (X<jats:sup>2</jats:sup> = 5.3, p &lt; 0.02), central nervous system infections (X<jats:sup>2</jats:sup> = 5.3, p &lt; 0.02), and early-onset seizures (X<jats:sup>2</jats:sup> = 4.1, p &lt; 0.04, df = 1). The results of multivariate analysis, on the other hand, indicated that the GOS score and motor deficit were of greater statistical importance (X<jats:sup>2</jats:sup> = 35.24, p &lt; 0.0001; and X<jats:sup>2</jats:sup> = 7.1, p &lt; 0.07, respectively). Factors that did have much statistically significant bearing on posttraumatic epilepsy were the projectile type, site of injury on the skull, patient age, number of affected lobes, related hemorrhagic complications, and retained metallic or bone fragments.</jats:p> <jats:p>Glasgow Outcome Scale score and focal motor neurological deficit are of particular importance in predicting posttraumatic epilepsy after missile head injury.</jats:p>

Correlates of posttraumatic epilepsy 35 years following combat brain injury

“…21 However, our data suggest that the onset of seizures may be delayed more than 30 years after TBI. The most common seizure type also changed over time, with an increased tendency to complex partial seizures in the later years subsequent to TBI.…”

“…Because both single and multiple gene mutations have been associated with epilepsy, [20][21][22] we screened for a number of genetic markers. These included APOE 4, glutamic acid decarboxylase (GAD), catechol-Omethyltransferase, GRIN (a glutamate receptor and a subunit of the NMDA), brain-derived neurotrophic factor, and dopamine ␤-hydroxylase.…”

Intracranially Retained Sewing Needle in a Child: Does the Rust on the Needle Have any Implication?

“…No relationship between retained bone fragments and seizure disorder has been found, whereas the presence of metal fragments, location and the size of the lesion have been demon- strated to correlate with the development of epilepsy [2]. However, other authors did not find such a correlation [9].…”

Perforating brain injury from a speargun. A case report

“…Penetrating head injury is more common than perforating which is often associated with increased risk of neurological complications, especially if the trajectory crosses the midline from a lateral entrance of the skull 1,4,7,9,12,14 .…”

“…The trajectory of the projectile in our patient did not suggest vascular damage, therefore an arteriography was not considered necessary. The prophylactic use of antiepileptic drugs is recommended in these patients even in the absence of early crisis due to the high probability of developing epilepsy later 1,22 . Our patient was treated with phenytoin every 8 hours for 6 months after surgery.…”