Early and late posttraumatic seizures following traumatic brain injury: A five-year follow-up survival study

Najafi, Mohammad Reza; Tabesh, Homayoun; Hosseini, Hamid; Akbari, Mojtaba; Najafi, Mohammad Amin

Early and late posttraumatic seizures following traumatic brain injury: A five-year follow-up survival study

Authors

¹ Department of Neurology, Isfahan Neuroscience Research Center, Isfahan University of Medical Science, Isfahan, Iran

² School of Medicine, Isfahan University of Medical Science, Isfahan, Iran

³ Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: The main objective of this study was to determine the incidence, time to event, and risk factors for posttraumatic seizures (PTS) following traumatic brain injury (TBI) in a five-year follow-up survival design.
Materials and Methods: In a cohort study, between September 2008 and October 2013, 411 traumatic brain injury patients referring to the Emergency Units (EUs) of the Isfahan University Hospitals, who met the inclusion criteria, entered the study. Follow-up evaluations were conducted by telephone conversation or clinical examination, if needed. The patients were followed for up to five years after TBI or until a first seizure event if it occurred prior to the five-year anniversary. The survival rate data were collected and measured for all patients under follow-up. Survival analysis on PTS and its related predictors was done using the Kaplan-Meier curves and the Cox proportional hazards regression. All analyses were done using STATA and SPSS statistical software, and P-values smaller than 0.05 were considered to be statistically significant.
Results: The median duration of follow-up was 36 months (Interquartile range: 23-50). A significantly greater number of first seizures occurred in the first year after injury than all other years (57.7%). The overall incidence of posttraumatic seizures, in this study population, was 6.33% (95% CI: 3.96-8.69). Among the participants, the incidence rates for early and late posttraumatic seizures were 1.95 and 4.38%, respectively. The result of the Cox regression analysis showed that the Glasgow Coma Scale (GCS) score and trauma severity were associated with PTS.
Conclusion: All in all, the present study highlighted the role of the trauma severity and GCS as effective factors in the incidence of seizure in patients with TBI. Particular care is advised for patients with these risk factors during the primary handling in the Emergency Units.

Keywords

References

1.	Barkley JM, Morales D, Hayman LA, Diaz-Marchan PJ. Static neuroimaging in the evaluation of TBI. Brain injury medicine: Principles and practice. 2007. p. 129-48.
2.	Shukla D, Devi BI, Agrawal A. Outcome measures for traumatic brain injury. Clin Neurol Neurosurg 2011;113:435-41.
3.	Coronado VG, Faul M, Wald MM, Xu L. Traumatic brain injury in the United States: Emergency department visits, hospitalizations, and deaths, 2002-2006: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.
4.	Wagner AK, Miller MA, Scanlon J, Ren D, Kochanek PM, Conley YP. Adenosine A1 receptor gene variants associated with post-traumatic seizures after severe TBI. Epilepsy Res 2010;90:259-72.
5.	Rajendra Acharya U, Vinitha Sree S, Swapna G, Martis RJ, Suri JS. Automated EEG analysis of epilepsy: A review. Knowledge-Based Systems. 2013.
6.	Labate D, Inuso G, Occhiuto G, La Foresta F, Morabito FC. Measures of brain connectivity through permutation entropy in epileptic disorders. Neural Nets and Surroundings: Springer; 2013. p. 59-67.
7.	Asconape J, Penry J. Poststroke seizures in the elderly. Clinics in Geriatric Medicine 1991;7:483-92.
8.	Frey LC. Epidemiology of posttraumatic epilepsy: A critical review. Epilepsia 2003;44:11-7.
9.	Jennett B. Epilepsy after non-missile head injuries. United Kingdom: Heinemann Medical; 1975.
10.	Annegers JF, Grabow JD, Groover RV, Laws ER, Elveback LR, Kurland LT. Seizures after head trauma A population study. Neurology 1980;30:683-9.
11.	Najafi MR, Abrishamkar S, Sonbolestan SA, Hamrah H. The effects of gabapentin on improvement of consciousness level in patients with traumatic brain injury: A randomized clinical trial. 2012.
12.	Annegers JF, Hauser WA, Coan SP, Rocca WA. A population-based study of seizures after traumatic brain injuries. N Engl J Med 1998;338:20-4.
13.	Annegers JF, Grabow JD, Kurland LT, Laws ER Jr. The incidence, causes, and secular trends of head trauma in Olmsted County, Minnesota, 1935-1974. Neurology 1980;30:912-9.
14.	Annegers JF, Coan SP. The risks of epilepsy after traumatic brain injury. Seizure 2000;9:453-7.
15.	Temkin NR. Risk factors for posttraumatic seizures in adults. Epilepsia 2003;44:18-20.
16.	Asikainen I, Kaste M, Sarna S. Early and late posttraumatic seizures in traumatic brain injury rehabilitation patients: Brain injury factors causing late seizures and influence of seizures on long-term outcome. Epilepsia 1999;40:584-9.
17.	Saadat S, Akbari H, Khorramirouz R, Mofid R, Rahimi-Movaghar V. Determinants of mortality in patients with traumatic brain injury. Ulus Travma Acil Cerrahi Derg 2012;18:219-24.
18.	Groswasser Z, Cohen M, Keren O. Female TBI patients recover better than males. Brain Inj 1998;12:805-8.
19.	Aghakhani N, Azami M, Jasemi M, Khoshsima M, Eghtedar S, Rahbar N. Epidemiology of traumatic brain injury in Urmia, Iran. Iran Red Crescent Med J 2013;15:173-4.
20.	Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas 1970.
21.	Garga N, Lowenstein DH. Posttraumatic epilepsy: A major problem in desperate need of major advances. Epilepsy Curr 2006;6:1-5.
22.	Englander J, Bushnik T, Duong TT, Cifu DX, Zafonte R, Wright J, et al. Analyzing risk factors for late posttraumatic seizures: A prospective, multicenter investigation. Arch Phys Med Rehabil 2003;84:365-73.
23.	Angeleri F, Majkowski J, Cacchio G, Sobieszek A, D'Acunto S, Gesuita R, et al. Posttraumatic epilepsy risk factors: One-year prospective study after head injury. Epilepsia 1999;40:1222-30.

Advanced Biomedical Research