Risk factors for late-onset seizures related to cerebral contusions in adults with a moderate traumatic brain injury

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Abstract

Objectives

This prospective study compares the characteristics of patients with a moderately severe traumatic brain injury (TBI) and cerebral contusions who develop late-onset seizures to those who do not.

Patients and methods

Thirty-nine adult TBI patients with cerebral contusions, who did not need a neurosurgical treatment, could be followed up for more than 3 years. Fourteen patients developed seizures during that period and 25 did not. The Glasgow Coma Scale (GCS) score on admission and the modified Rankin (mR) score on discharge from the hospital, the computed tomography (CT) and/or magnetic resonance imaging (MRI) findings, the electroencephalogram (EEG) patterns as well as the vascular and habit risk factors were compared between both groups.

Results

The mean GCS and mR scores were moderately severe and comparable between both groups. Early-onset seizures represented 21.4%. The overall seizure recurrence was 85.7% after treatment with carbamazepine or valproate sodium. Still 3 patients did not remain seizure-free after addition of another antiepileptic drug. The average number of brain contusions on CT/MRI was approximately the same. Vascular risk factors and alcohol abuse were more observed in the seizure patients. Abnormal EEG findings on discharge from the hospital were significantly more frequent in the patients who developed late-onset seizures afterward (P < 0.05).

Conclusions

Seizures after non-complicated cerebral contusions are difficult to treat. Vascular risk factors and alcohol abuse may also predispose to their occurrence. The EEG findings after the TBI are highly predictive.

Introduction

The overall risk for trauma-related seizures in the civilian population has been estimated between 2 and 5% [1]. The cumulative 5-year probability was estimated at 0.5% in patients with mild injury, 1.2% for those with moderate injuries and 10% in those with severe injuries [2]. Acute intracerebral haematoma, brain contusion, increased injury severity, occurrence of early-onset seizures and being older than 65 years at the time of injury were considered as important independent risk factors for post-traumatic or late-onset seizures [3]. However, as early seizures overlap with those of late-onset ones, they were not identified as an independent risk factor in multivariate analysis in a population-based study [2].

In a prospective multi-center study factors associated with the highest cumulative probability for late-onset seizures included bi-parietal contusions and dural penetration by bone fragments [4]. Traumatic lesions of the frontal lobes were found to be the most significant risk factor for the development of seizures and epilepsy in another study [5]. Seizures were also found to be more associated to hypoperfusion in the temporal lobes on single-photon emission tomography [6]. All these data suggest that further stratification of the neuroimaging findings in patients with non-complicated cerebral contusions are needed to define the risk of developing posttraumatic seizures and epilepsy.

The present small prospective study compares the characteristics of patients with a moderately severe traumatic brain injury (TBI) and cerebral contusions who developed late-onset seizures to those who did not.

Section snippets

Patients and methods

This prospective study concerns 39 selected adult patients (14 women and 25 males) with a moderate TBI and cerebral contusions, who were admitted to the neurological department of the University Hospital of Ghent between 2002 and 2005. None of the patients needed a neurosurgical intervention and their neurological status on admission was considered stable enough to be admitted to a non-surgical department. Patients with a Glasgow Coma Scale (GCS) score of less than 9 on admission or those who

Results

The main age of the patients who developed seizures was somewhat older than of those who did not: 64 (IQR 58–76) years in the former and 59 (IQR 47–79) years (P = 0.280). There was a male predominance with 57.1% in the seizure group and 68.0% in the non-seizure group (P = 0.729). The main GCS score on admission was 12 (IQR 10–15) in the former and 14 (IQR 12–15) in the latter group (P = 0.992). The main mR score on discharge from the hospital was respectively 0 (IQR 0–3) and 0 (IQR 0–3) (P = 0.978).

The

Discussion

The small size of the present pilot study allows only identifying trends of differences in risk factors for the occurrence of late-onset seizures in a subgroup of patients with isolated cerebral contusions. It is well known that the severity of the head trauma, the extent of tissue loss, the presence or absence of an acute cerebral haematoma and patient's age determine the severity of post-traumatic epilepsy [3], [5], [9]. The present study is restricted to patients with a moderately severe TBI

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