A prospective study to determine the risk factors associated with post traumatic seizures: A single institution experience
- Department of Neurosurgery, Parkash Hospital, Bhatinda, India.
- Department of Surgery, Government Medical College, Rajindra Hospital, Patiala, India.
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Saurabh Sharma, Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
DOI:10.25259/SNI_985_2022Copyright: © 2023 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Tarun Garg1, Raghav Sood2, Akshay Chaudhary3, Shivender Sobti4, Saurabh Sharma4, Ashwani K. Chaudhary4, Hanish Bansal4, Jagminder Singh4, Manish Sharma4. A prospective study to determine the risk factors associated with post traumatic seizures: A single institution experience. 21-Apr-2023;14:143
How to cite this URL: Tarun Garg1, Raghav Sood2, Akshay Chaudhary3, Shivender Sobti4, Saurabh Sharma4, Ashwani K. Chaudhary4, Hanish Bansal4, Jagminder Singh4, Manish Sharma4. A prospective study to determine the risk factors associated with post traumatic seizures: A single institution experience. 21-Apr-2023;14:143. Available from: https://surgicalneurologyint.com/surgicalint-articles/12280/
Background: Post traumatic seizures (PTS) are a known sequel of traumatic brain injury (TBI). Incidence of PTS is dependent on many factors including study design and characteristics of the study population. As incidence of TBI increases and death due to TBI decreases, more individuals will be at risk of developing and living with chronic complications. The objective of the present study was to determine the frequency and risk factors for PTS following TBI.
Methods: A prospective study was conducted on patients admitted with TBI from April 1, 2019, to May 31, 2020, to determine the frequency, time to event, and risk factors for PTS following TBI. We classified the severity of head injury using a standard criterion, into mild, moderate and severe injury. Follow-up of 3 months was undertaken for all patients. Variables include age, sex, trauma severity, Glasgow coma scale, onset of PTS, and neuroradiological finding.
Results: We enrolled 450 post traumatic subjects, out of which 36 (8%) developed seizures. Of the total of 36 patients detected to have hemorrhagic contusion on computerized tomography scan, 12 patients developed seizures. We found that the independent risk factors associated with occurrence of PTS were frontal— temporal lobar contusion and severity of head injury. All these findings were statistically significant.
Conclusion: We found that the independent risk factors associated with occurrence of PTS were frontal-temporal lobar contusion and severity of head injury. Type of management (Operative vs. Non operative) does not affect the outcome of PTS.
Keywords: Antiepileptic, Head injury, Post traumatic seizures, Traumatic brain injury
Traumatic brain injury (TBI) is a significant public health concern and is a major cause of morbidity and mortality, especially in patients <45 years.[
Individuals with more severe injury are particularly affected by chronic conditions associated with TBI. Among individuals who survive a severe TBI, disability rates are estimated as high as 77%.[
Despite decades of research, there are no effective pharmacological interventions to prevent post-traumatic seizures (PTS) that develop after 7 days post injury and, it does not appear that rates of PTS are decreasing.[
A prospective study was conducted on patients admitted with TBI in a Tertiary care Centre in North India from April 1, 2019, to May 31, 2020. Prior ethics committee permission was obtained and written informed consent was taken from each participant before including them in the study.
All patients who presented with acute TBI in the hospital were included in the study.
(1) A preceding history of brain injury or major mental disorder, (2) Pregnancy, (3) Predisposition to seizures (such as a history of brain tumor or stroke), (4) Family history of seizures.
In this study, we used the classification of head injury severity as defined by Annegers et al.[
All statistical calculations were done using 17 Statistical Package for the Social Science 21 version statistical program for Microsoft Windows.
In our study, 450 post traumatic patients were included in the study. Thirty-six (8%) patients developed seizures. Patients with seizures were classified into three categories based on the GCS score. The group with GCS score of 3–6 had 15 patients developing seizures out of 275 patients. The group with GCS score of 7–12 had nine patients developing seizures out of 78 patients. The group with GCS score of 13–15 had 12 numbers of patients developing seizures out of 97 patients. Mean GCS of patients developing seizure is 12.28 ± 3.551 [
In our study, total number of patients were 450, 22 patients below the age group of 20 out of which two developed seizures (5.6%). One hundred and thirty-eight patients in the age group of 21–30 years, out of which 16 developed seizures (44.4%). Eighty-seven patients were in the age group of 31–40, out of which seven developed seizures (19.4%). Ninety patients were in the age group of 41–50, out of which five developed seizures (13.9). Fifty-seven patients were in the age group of 51–60, out of which four developed seizures (11.1%). Fifty-six patients had age more than 60 year, out of which two developed seizures (5.6%). Mean age of patients developing seizure is 36.14 ± 13.7 [
In our study, out of 450 patients, 366 were males and 84 were females. Thirty-three males and three females developed seizures [
Patients were also classified on the basis of computerized tomography (CT) findings. Of the total of 36 patients detected to have hemorrhagic contusion on CT scan, 12 patients developed seizures (33%). Of the total of eight patients diagnosed diffuse axonal injury, one patient developed seizures (12.5%). Of the total of 70 patients detected to have depressed fracture on CT scan, seven developed seizures (10%). Forty-seven patients who were diagnosed as a case of extradural hemorrhage on CT scan, one patient developed seizures (2%). Of the total of 61 patients diagnosed subarachnoid hemorrhage on CT scan, six patients developed seizures (9.8%), of the total of 131 patients detected to have subdural hemorrhage on CT scan, nine patients developed seizures (6.8%). Of the two patients diagnosed with intraparenchymal hemorrhage, none developed seizures. Of the total 450 patients, 270 were managed conservatively and 180 patients were operated. Twenty patients out of 270 patients had seizures.
One hundred and eighty patients were operated, 16 had seizures [
In our study, 450 patients with diagnosis of TBI were evaluated. The patients underwent detailed clinical evaluation and radiological investigation as and when indicated. In a study conducted by Lee et al., total of 4232 consecutively treated adult patients with mild closed head injury were examined. They ranged in age from 16 to 88 years mean (32.82 years); the male: Female ratio was 3.8:1. The most common causes of trauma are motorcycle accidents (53.78%) and pedestrian injury (28.89%). In 100 patients (2.36) who developed seizures within the1st week after head injury, the male: female was 7:1, the mean age was 29.74 years.[
In this study, subjects that were 21–30 years at age were more likely to develop PTS than subjects >30 years of age, but no significant difference between subjects 21–50 and those >50 years. Immaturity of the brain, which has been offered as the explanation for the greater susceptibility of children to early PTS, may explain the greater susceptibility of the younger age groups for seizures.
In our study, the overall incidence of PTS was found to be 8%. The incidence in normal civilian is 1.8–5%.[
Several reports (Annegers et al.; Angeleri et al.; Englander et al.) have shown cerebral contusion was indeed a risk factor.[
A possible explanation for this may be the following; Cortical neurons are injured following contusions and this would lead the iron from the blood deposited in the cortex; the deposited iron would lead to iron induced membrane peroxidation and would make the seizure spread to the subcortical areas (hippocampus mainly); the occurrence and evolution of the epileptiform activity in the subcortical structures would in parallel with that in the cortical focus.[
TBI severity measured by GCS score is also a risk factor in this study. The patients with lower GCS scores (more severe injury) have more risk to develop PTS.[
In our study, we used GCS score to measure the TBI severity and the results were consistent with the former studies. We found that the patients with GCS scores from 3 to 8 had the highest seizure frequency (19.9%) and the highest risk to develop PTS (4.103 times risk rate). However, some studies showed that the GCS score is not a risk factor. Englander et al.[
In this study of TBI patients, frontal-temporal lobar contusion and severity of TBI measured by initial GCS were significant in the multivariate model analysis. The reason PTS happens still needs to be investigated. Thorough follow-up of patients with PTS and antiepileptic therapy may attain rehabilitation goals.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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