Association of Posttraumatic Epilepsy With Long-term Functional Outcomes in Individuals With Severe Traumatic Brain Injury.

Humans Retrospective Studies Brain Injuries, Traumatic / therapy Prognosis Glasgow Outcome Scale Epilepsy / complications

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
09 05 2023
Historique:
received: 09 07 2022
accepted: 27 01 2023
pmc-release: 09 05 2024
medline: 10 5 2023
pubmed: 23 3 2023
entrez: 22 3 2023
Statut: ppublish

Résumé

Nearly one-third of patients with severe traumatic brain injury (TBI) develop posttraumatic epilepsy (PTE). The relationship between PTE and long-term outcomes is unknown. We tested whether, after controlling for injury severity and age, PTE is associated with worse functional outcomes after severe TBI. We performed a retrospective analysis of a prospective database of patients with severe TBI treated from 2002 through 2018 at a single level 1 trauma center. Glasgow Outcome Scale (GOS) was collected at 3, 6, 12, and 24 months postinjury. We used repeated-measures logistic regression predicting GOS, dichotomized as favorable (GOS 4-5) and unfavorable (GOS 1-3), and a separate logistic model predicting mortality at 2 years. We used predictors as defined by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) base model (i.e., age, pupil reactivity, and GCS motor score), PTE status, and time. Of 392 patients who survived to discharge, 98 (25%) developed PTE. The proportion of patients with favorable outcomes at 3 months did not differ between those with and without PTE (23% [95% Confidence Interval [CI]: 15%-34%] vs 32% [95% CI: 27%-39%]; Posttraumatic epilepsy is associated with impaired recovery from severe TBI and poor functional outcomes. Early screening and treatment of PTE may improve patient outcomes.

Sections du résumé

BACKGROUND AND OBJECTIVE
Nearly one-third of patients with severe traumatic brain injury (TBI) develop posttraumatic epilepsy (PTE). The relationship between PTE and long-term outcomes is unknown. We tested whether, after controlling for injury severity and age, PTE is associated with worse functional outcomes after severe TBI.
METHODS
We performed a retrospective analysis of a prospective database of patients with severe TBI treated from 2002 through 2018 at a single level 1 trauma center. Glasgow Outcome Scale (GOS) was collected at 3, 6, 12, and 24 months postinjury. We used repeated-measures logistic regression predicting GOS, dichotomized as favorable (GOS 4-5) and unfavorable (GOS 1-3), and a separate logistic model predicting mortality at 2 years. We used predictors as defined by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) base model (i.e., age, pupil reactivity, and GCS motor score), PTE status, and time.
RESULTS
Of 392 patients who survived to discharge, 98 (25%) developed PTE. The proportion of patients with favorable outcomes at 3 months did not differ between those with and without PTE (23% [95% Confidence Interval [CI]: 15%-34%] vs 32% [95% CI: 27%-39%];
DISCUSSION
Posttraumatic epilepsy is associated with impaired recovery from severe TBI and poor functional outcomes. Early screening and treatment of PTE may improve patient outcomes.

Identifiants

DOI: 10.1212/WNL.0000000000207183 PMID: 36948595 PMC: PMC10186228
pubmed: 36948595
pii: WNL.0000000000207183
doi: 10.1212/WNL.0000000000207183
pmc: PMC10186228
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e1967-e1975

Informations de copyright

© 2023 American Academy of Neurology.

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Auteurs

Matthew Pease (M)

From the Departments of Neurosurgery (M.P., A.N., D.O.O., J.G-M.), Neurology (J.E., L.S., N.B., J.F.C.), Critical Care (J.E., L.S.), and Emergency Medicine (J.E.), University of Pittsburgh Medical Center, PA. pease.matthew@gmail.com.
ORCID: 0000-0001-6125-9858

Arka N Mallela (AN)

From the Departments of Neurosurgery (M.P., A.N., D.O.O., J.G-M.), Neurology (J.E., L.S., N.B., J.F.C.), Critical Care (J.E., L.S.), and Emergency Medicine (J.E.), University of Pittsburgh Medical Center, PA.
ORCID: 0000-0003-0993-198X

Jonathan Elmer (J)

From the Departments of Neurosurgery (M.P., A.N., D.O.O., J.G-M.), Neurology (J.E., L.S., N.B., J.F.C.), Critical Care (J.E., L.S.), and Emergency Medicine (J.E.), University of Pittsburgh Medical Center, PA.

David O Okonkwo (DO)

From the Departments of Neurosurgery (M.P., A.N., D.O.O., J.G-M.), Neurology (J.E., L.S., N.B., J.F.C.), Critical Care (J.E., L.S.), and Emergency Medicine (J.E.), University of Pittsburgh Medical Center, PA.
ORCID: 0000-0002-7444-2851

Lori Shutter (L)

From the Departments of Neurosurgery (M.P., A.N., D.O.O., J.G-M.), Neurology (J.E., L.S., N.B., J.F.C.), Critical Care (J.E., L.S.), and Emergency Medicine (J.E.), University of Pittsburgh Medical Center, PA.

Niravkumar Barot (N)

From the Departments of Neurosurgery (M.P., A.N., D.O.O., J.G-M.), Neurology (J.E., L.S., N.B., J.F.C.), Critical Care (J.E., L.S.), and Emergency Medicine (J.E.), University of Pittsburgh Medical Center, PA.

Jorge Gonzalez-Martinez (J)

From the Departments of Neurosurgery (M.P., A.N., D.O.O., J.G-M.), Neurology (J.E., L.S., N.B., J.F.C.), Critical Care (J.E., L.S.), and Emergency Medicine (J.E.), University of Pittsburgh Medical Center, PA.

James F Castellano (JF)

From the Departments of Neurosurgery (M.P., A.N., D.O.O., J.G-M.), Neurology (J.E., L.S., N.B., J.F.C.), Critical Care (J.E., L.S.), and Emergency Medicine (J.E.), University of Pittsburgh Medical Center, PA.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Association of Posttraumatic Epilepsy With...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Association of Posttraumatic Epilepsy With...
questionsmedicales.fr › Plaies et blessures › Traumatismes du système nerveux › Traumatismes cranioencéphaliques › Lésions encéphaliques › Lésions traumatiques de l'encéphale › Association of Posttraumatic Epilepsy With...
questionsmedicales.fr › Diagnostic › Pronostic › Association of Posttraumatic Epilepsy With...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Échelle de suivi de Glasgow › Association of Posttraumatic Epilepsy With...
questionsmedicales.fr › Maladies du système nerveux › Maladies du système nerveux central › Encéphalopathies › Épilepsie › Association of Posttraumatic Epilepsy With...