Background Traumatic brain injury (TBI) causes early seizures and is the leading cause of post-traumatic epilepsy. We prospectively assessed structural imaging biomarkers differentiating patients who develop seizures secondary to TBI from patients who do not.
Design Multicentre prospective cohort study starting in 2018. Imaging data are acquired around day 14 post-injury, detection of seizure events occurred early (within 1 week) and late (up to 90 days post-TBI).
Results From a sample of 96 patients surviving moderate-to-severe TBI, we performed shape analysis of local volume deficits in subcortical areas (analysable sample: 57 patients; 35 no seizure, 14 early, 8 late) and cortical ribbon thinning (analysable sample: 46 patients; 29 no seizure, 10 early, 7 late). Right hippocampal volume deficit and inferior temporal cortex thinning demonstrated a significant effect across groups. Additionally, the degree of left frontal and temporal pole thinning, and clinical score at the time of the MRI, could differentiate patients experiencing early seizures from patients not experiencing them with 89% accuracy.
Conclusions and relevance Although this is an initial report, these data show that specific areas of localised volume deficit, as visible on routine imaging data, are associated with the emergence of seizures after TBI.
- traumatic brain injury
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Collaborators Agoston, Denes, Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences; Au, Alicia K., Critical Care Medicine, University of Pittsburgh Medical Center; Bell, Michael, Critical Care Medicine, Children’s National Hospital DC; Churn, Ben, NINDS, National Institute of Health; Claassen, Jan, Neurology, Columbia University; Diaz-Arrastia, Ramon, Neurology, University of Pennsylvania; Engel, Jerome Jr, Neurology, University of California Los Angeles; Foreman, Brandon, Neurology and Rehabilitation Medicine, University of Cincinnati Medical Center; Galanopoulou, Aristea, Neurology, Albert Einstein College of Medicine; Gilmore, Emily, Neurocritical Care, Yale University; Hunn, Martin, Neurosurgery, The Alfred/Monash University; Jette, Nathalie, Neurology, Icahn School of Medicine at Mount Sinai; Morokoff, Andrew, Surgery, Royal Melbourne Hospital/The University of Melbourne; Moshé, Solomon L., Neurology, Albert Einstein College of Medicine; O'Brien, Terence, Neurology, The Alfred/Monash University/The University of Melbourne; Laing, Joshua, Neurology, The Alfred/Monash University; Perucca, Piero, Neurology, The Royal Melbourne Hospital/Monash University; O'Phelan, Kristine H., Neurology, University of Miami; Pitkanen, Asla, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland; Rosenthal, Eric, Neurology, Massachusetts General Hospital and Harvard University; Willyerd, Frederick, Phoenix Children's Hospital; Zimmermann, Lara, Neurology, University of California Davis Medical Center; Ellingson, Ben, Radiology, University of California Los Angeles; Buitrago Blanco, Manuel, Neurology, University of California Los Angeles; Correa, Daniel, Neurology, Montefiore Medical Center; Harrar, Dana, Pediatrics, Children's National Hospital DC; Bleck, Thomas P., Neurology, Northwestern University; Appavu, Brian, Neurology, Phoenix Children's Hospital; Struck, Aaron, Neurology, University of Wisconsin; Allen, Baxter, Neurology, Weill Cornell; Keselman, Inna, Neurology, University of California Los Angeles Health; Kennedy, Jeff, Neurology, University of California Davis Medical Center; Ferastraoaru, Victor, Neurology, Albert Einstein College of Medicine; Yoo, Ji Yeoun, Neurology, Icahn School of Medicine at Mount Sinai.
Contributors PMV, MMM and AWT conceived the study; ESL and MMM performed the analysis; CR, VS and JRT co-ordinated and performed data collection; ESL and MMM drafted the manuscript; all authors contributed critical revisions.
Funding This work was funded by NINDS Center without Walls, U54 NS100064 (EpiBioS4Rx), and by Tiny Blue Dot foundation.
Competing interests DM reports personal fees from Wiley Publishing, outside the submitted work.
Patient consent for publication Not required.
Ethics approval This work was approved by the UCLA Institutional Review Board (IRB# 16-001 576) and the local review boards at each EpiBioS4Rx Study Group institution. Assent and written consent was obtained from the legal representative as per state law.
Provenance and peer review Not commissioned; externally peer reviewed.
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