Early seizures and temporal lobe trauma predict post-traumatic epilepsy: A longitudinal study

Meral A. Tubi, Evan Lutkenhoff, Manuel Buitrago Blanco, David McArthur, Pablo Villablanca, Benjamin Ellingson, Ramon Diaz-Arrastia, Paul Van Ness, Courtney Real, Vikesh Shrestha, Jerome Engel, Paul M. Vespa, EpiBioS4Rx Study Group Investigators, Denes Agoston, Alicia Au, Michael J. Bell, Tom Bleck, Craig Branch, Manuel Buitrago Blanco, Ross BullockBrian T. Burrows, Jan Claassen, Robert Clarke, James Cloyd, Lisa Coles, Karen Crawford, Ramon Diaz-Arrastia, Dominique Duncan, Benjamin Ellingson, Jerome Engel, Brandon Foreman, Aristea Galanopoulou, Emily Gilmore, Grohn Olli, Neil Harris, Jed Hartings, Hirsch Lawrence, Martin Hunn, Nathalie Jette, Leigh Johnston, Nigel Jones, Andres Kanner, David McArthur, Martin Monti, Andrew Morokoff, Solomon Moshe, Wenzhu Mowrey, Terence O'Brien, Kristine O'Phelan, Asla Pitkanen, Rema Raman, Courtney Robertson, Eric Rosenthal, Sandy Shultz, Terrance Snutch, Richard Staba, Arthur Toga, Jack Van Horn, Paul Vespa, Frederick Willyerd, Lara Zimmermann

Research output: Contribution to journalReview ArticleResearchpeer-review

19 Citations (Scopus)

Abstract

Objective: Injury severity after traumatic brain injury (TBI) is a well-established risk factor for the development of post-traumatic epilepsy (PTE). However, whether lesion location influences the susceptibility of seizures and development of PTE longitudinally has yet to be defined. We hypothesized that lesion location, specifically in the temporal lobe, would be associated with an increased incidence of both early seizures and PTE. As secondary analysis measures, we assessed the degree of brain atrophy and functional recovery, and performed a between-group analysis, comparing patients who developed PTE with those who did not develop PTE. Methods: We assessed early seizure incidence (n = 90) and longitudinal development of PTE (n = 46) in a prospective convenience sample of patients with moderate-severe TBI. Acutely, patients were monitored with prospective cEEG and a high-resolution Magnetic Resonance Imaging (MRI) scan for lesion location classification. Chronically, patients underwent a high-resolution MRI, clinical assessment, and were longitudinally monitored for development of epilepsy for a minimum of 2 years post-injury. Results: Early seizures, occurring within the first week post-injury, occurred in 26.7% of the patients (n = 90). Within the cohort of subjects who had evidence of early seizures (n = 24), 75% had a hemorrhagic temporal lobe injury on admission. For longitudinal analyses (n = 46), 45.7% of patients developed PTE within a minimum of 2 years post-injury. Within the cohort of subjects who developed PTE (n = 21), 85.7% had a hemorrhagic temporal lobe injury on admission and 38.1% had early (convulsive or non-convulsive) seizures on cEEG monitoring during their acute ICU stay. In a between-group analysis, patients with PTE (n = 21) were more likely than patients who did not develop PTE (n = 25) to have a hemorrhagic temporal lobe injury (p < 0.001), worse functional recovery (p = 0.003), and greater temporal lobe atrophy (p = 0.029). Conclusion: Our results indicate that in a cohort of patients with a moderate-severe TBI, 1) lesion location specificity (e.g. the temporal lobe) is related to both a high incidence of early seizures and longitudinal development of PTE, 2) early seizures, whether convulsive or non-convulsive in nature, are associated with an increased risk for PTE development, and 3) patients who develop PTE have greater chronic temporal lobe atrophy and worse functional outcomes, compared to those who do not develop PTE, despite matched injury severity characteristics. This study provides the foundation for a future prospective study focused on elucidating the mechanisms and risk factors for epileptogenesis.

Original languageEnglish
Pages (from-to)115-121
Number of pages7
JournalNeurobiology of Disease
Volume123
DOIs
Publication statusPublished - 1 Mar 2019
Externally publishedYes

Keywords

  • Brain atrophy
  • Brain trauma
  • Coma
  • Post-traumatic epilepsy
  • Seizures
  • Status epilepticus

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