Posttraumatic epilepsy linked to TBI incidence

Although the rate of self-reporting was low, patients with posttraumatic epilepsy within 1 year of a traumatic brain injury sustained negative functional outcomes, according to a cohort study published in JAMA Network Open.

“Patients with TBI can develop late symptomatic seizures, usually more than 7 days after injury, which is referred to as posttraumatic epilepsy (PTE). TBI accounts for approximately 4% of focal epilepsy in the general population and is the leading cause of epilepsy with onset in young adulthood (age 15 to 24 years),” John Burke, MD, PhD, from the department of neurosurgery at the University of California, San Francisco, and colleagues wrote.

“Epilepsy resulting from brain trauma is often difficult to control with medical therapy and is the cause of epilepsy in approximately 5% of patients referred to specialized epilepsy centers.”

Researchers sought to determine the frequency of occurrence, risk factors and association with functional outcomes and physical concerns of self-reported PTE in a large, prospectively collected TBI cohort.

The study was undertaken as a part of the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study and identified patients presenting with TBI to one of 18 participating level-1 U.S. trauma centers from February 2014 to July 2018. Data were subsequently analyzed between January 2020 and April 2021.

Patient information was collected according to TBI Common Data Elements, and occurrence of self-reported PTE was assessed using a questionnaire aimed at discovering symptoms of various neurological disorders.

Among 3,296 initial participants, 3,044 met inclusion criteria and 1,885 enrollees (mean age, 41.3 years; 65.8% men) had follow-up information at 12 months, including 1,493 patients with TBI.

In assessing the screening questionnaire, data showed the incidence of PTE after TBI was 2.7% at 12 months after injury. However, researchers noted that because PTE is associated with unfavorable outcomes, medical professionals should be acutely aware that PTE is likely to occur within a short time frame following TBI and consider treatments intended to prevent epileptic episodes as needed.

“We found that patients self-reporting a diagnosis of PTE had less favorable functional, cognitive and emotional outcomes, after accounting for age, [Glasgow Coma Scale] GCS on presentation and cranial CT findings,” Burke and colleagues wrote.

“These data are novel because studies examining outcomes after PTE have typically not shown a major association with overall outcome in adults,” they added.