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Seizures in Critical Care pp 119–136Cite as

Traumatic Brain Injury and Seizures in the ICU

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Abstract

Seizures may occur in up to 22% of ICU patients with severe traumatic brain injury. There is a relatively high risk of nonconvulsive seizures in this population. Seizures may exacerbate the injury process and disrupt both patient care and family coping. Therefore, seizures should be recognized quickly and treated promptly. The clinician should have a high index of suspicion for seizures, especially in patients with clearly defined risk factors for seizure development. Continuous EEG monitoring should be considered in those patients who are considered to be at high risk of clinical or subclinical seizures. Seizure prophylaxis with antiepileptics is supported by the literature for the prevention of early seizures (defined as < 7 days post-injury) but not for late seizures. Phenytoin and carbamazepine have been used in this setting, and both have been found to be efficacious in preventing early seizures. Phenytoin has several features that make it the best first line agent. Anticonvulsants have not been found to reduce the incidence of developing late posttraumatic seizures and therefore, prolonged prophylaxis with antiepileptics is not currently supported.

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References

  1. Sosin DM, Sniezek JE, Thurman DJ (1996) Incidence of mild and moderate brain injury in the United States, 1991. Brain Inj 10(1):47–54

    Article  PubMed  CAS  Google Scholar 

  2. Thurman D, Guerrero J (1999) Trends in hospitalization associated with traumatic brain injury. JAMA 282(10):954–957

    Article  PubMed  CAS  Google Scholar 

  3. Sosin DM, Sniezek JE, Waxweiler RJ (1995) Trends in death associated with traumatic brain injury, 1979 through 1992. Success and failure. JAMA 273(22):1778–1780

    Article  PubMed  CAS  Google Scholar 

  4. Annegers JF, Grabow JD, Kurland LT, Laws ER Jr (1980) The incidence, causes, and secular trends of head trauma in Olmsted County, Minnesota, 1935–1974. Neurology 30(9):912–919

    Article  PubMed  CAS  Google Scholar 

  5. Annegers JF, Hauser WA, Coan SP, Rocca WA (1998) A population-based study of seizures after traumatic brain injuries. N Engl J Med 338(1):20–24

    Article  PubMed  CAS  Google Scholar 

  6. Lee ST, Lui TN, Wong CW, Yeh YS, Tzaan WC (1995) Early seizures after moderate closed head injury. Acta Neurochir (Wien) 137(3–4):151–154

    Article  CAS  Google Scholar 

  7. Salazar AM, Jabbari B, Vance SC, Grafman J, Amin D, Dillon JD (1985) Epilepsy after penetrating head injury. I. Clinical correlates: a report of the Vietnam Head Injury Study. Neurology 35(10):1406–1414

    Article  PubMed  CAS  Google Scholar 

  8. Hauser WA (1990) Prevention of post-traumatic epilepsy. N Engl J Med 323(8):540–542

    Article  PubMed  CAS  Google Scholar 

  9. Hauser WA, Tabaddor K, Factor PR, Finer C (1984) Seizures and head injury in an urban community. Neurology 34(6):746–751

    Article  PubMed  CAS  Google Scholar 

  10. Jennett WB (1975) Epilepsy after nonmissile head injuries, 2nd edn. Heinemann, London

    Google Scholar 

  11. Temkin NR, Dikmen SS, Wilensky AJ, Keihm J, Chabal S, Winn HR (1990) A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med 323(8):497–502

    Article  PubMed  CAS  Google Scholar 

  12. Kollevold T (1976) Immediate and early cerebral seizures after head injuries. Part I. J Oslo City Hosp 26(12):99–114

    PubMed  CAS  Google Scholar 

  13. Black P, Shepard RH, Walker AE (1975) Outcome of head trauma: age and post-traumatic seizures. Ciba Found Symp (34):215–226

    Google Scholar 

  14. Scholtes FB, Renier WO, Meinardi H (1994) Generalized convulsive status epilepticus: causes, therapy, and outcome in 346 patients. Epilepsia 35(5):1104–1112

    Article  PubMed  CAS  Google Scholar 

  15. Englander J, Bushnik T, Duong TT, Cifu DX, Zafonte R, Wright J et al (2003) Analyzing risk factors for late posttraumatic seizures: a prospective, multicenter investigation. Arch Phys Med Rehabil 84(3):365–373

    Article  PubMed  Google Scholar 

  16. Frey LC (2003) Epidemiology of posttraumatic epilepsy: a critical review. Epilepsia 44(Suppl 10):11–17

    Article  PubMed  Google Scholar 

  17. Vespa PM, Miller C, McArthur D, Eliseo M, Etchepare M, Hirt D, Glenn TC, Martin N, Hovda D (2007) Nonconvulsive electrographic seizures after traumatic brain injury results in intracranial pressure and metabolic crisis. Crit Care Med 35(12):2830–2836

    Article  PubMed  Google Scholar 

  18. Wiedemayer H, Triesch K, Schafer H, Stolke D (2002) Early seizures following non-penetrating traumatic brain injury in adults: risk factors and clinical significance. Brain Inj 16(4):323–330

    Article  PubMed  Google Scholar 

  19. Annegers JF, Grabow JD, Groover RV, Laws ER Jr, Elveback LR, Kurland LT (1980) Seizures after head trauma: a population study. Neurology 30(7 Pt 1):683–689

    Article  PubMed  CAS  Google Scholar 

  20. Vespa PM, Nuwer MR, Nenov V, Ronne-Engstrom E, Hovda DA, Bergsneider M et al (1999) Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg 91(5):750–760

    Article  PubMed  CAS  Google Scholar 

  21. Young GB, Jordan KG, Doig GS (1996) An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 47(1):83–89

    Article  PubMed  CAS  Google Scholar 

  22. Ronne-Engrstrom E, Winkler T (2006) Continuous EEG monitoring in patients with traumatic brain injury reveals a high incidence of epileptiform activity. Acta Neurol Scand 114(1):47–53

    Article  Google Scholar 

  23. Temkin NR (2003) Risk factors for posttraumatic seizures in adults. Epilepsia 44(Suppl 10):18–20

    Article  PubMed  Google Scholar 

  24. Mansfield RT (1997) Head injuries in children and adults. Crit Care Clin 13(3):611–628

    Article  PubMed  CAS  Google Scholar 

  25. Jennett WB, Lewin W (1960) Traumatic epilepsy after closed head injuries. J Neurol Neurosurg Psychiatry 23:295–301

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  26. Ottman R, Lee JH, Risch N, Hauser WA, Susser M (1996) Clinical indicators of genetic susceptibility to epilepsy. Epilepsia 37(4):353–361

    Article  PubMed  CAS  Google Scholar 

  27. Diaz-Arrastia R, Gong Y, Fair S, Scott KD, Garcia MC, Carlile MC et al (2003) Increased risk of late posttraumatic seizures associated with inheritance of APOE epsilon4 allele. Arch Neurol 60(6):818–822

    Article  PubMed  Google Scholar 

  28. Desai BT, Whitman S, Coonley-Hoganson R, Coleman TE, Gabriel G, Dell J (1983) Seizures and civilian head injuries. Epilepsia 24(3):289–296

    Article  PubMed  CAS  Google Scholar 

  29. McCrory PR, Bladin PF, Berkovic SF (1997) Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome. BMJ 314(7075):171–174

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  30. McCrory PR, Berkovic SF (2000) Video analysis of acute motor and convulsive manifestations in sport- related concussion. Neurology 54(7):1488–1491

    Article  PubMed  CAS  Google Scholar 

  31. Hahn YS, Fuchs S, Flannery AM, Barthel MJ, McLone DG (1988) Factors influencing posttraumatic seizures in children. Neurosurgery 22(5):864–867

    Article  PubMed  CAS  Google Scholar 

  32. Lewis RJ, Yee L, Inkelis SH, Gilmore D (1993) Clinical predictors of post-traumatic seizures in children with head trauma. Ann Emerg Med 22(7):1114–1118

    Article  PubMed  CAS  Google Scholar 

  33. Ong LC, Dhillon MK, Selladurai BM, Maimunah A, Lye MS (1996) Early post-traumatic seizures in children: clinical and radiological aspects of injury. J Paediatr Child Health 32(2):173–176

    Article  PubMed  CAS  Google Scholar 

  34. Hahn YS, Chyung C, Barthel MJ, Bailes J, Flannery AM, McLone DG (1988) Head injuries in children under 36 months of age. Demography and outcome. Childs Nerv Syst 4(1):34–40

    PubMed  CAS  Google Scholar 

  35. Hendrick EB, Harris L (1968) Post-traumatic epilepsy in children. J Trauma 8(4):547–556

    Article  PubMed  CAS  Google Scholar 

  36. Marmarou A, Foda MA, van den Brink W, Campbell J, Kita H, Demetriadou K (1994) A new model of diffuse brain injury in rats. Part I: Pathophysiology and biomechanics. J Neurosurg 80(2):291–300

    Article  PubMed  CAS  Google Scholar 

  37. Nilsson P, Ronne-Engstrom E, Flink R, Ungerstedt U, Carlson H, Hillered L (1994) Epileptic seizure activity in the acute phase following cortical impact trauma in rat. Brain Res 637(1–2):227–232

    Article  PubMed  CAS  Google Scholar 

  38. Beaumont A, Marmarou A, Czigner A, Yamamoto M, Demetriadou K, Shirotani T et al (1999) The impact-acceleration model of head injury: injury severity predicts motor and cognitive performance after trauma. Neurol Res 21(8):742–754

    PubMed  CAS  Google Scholar 

  39. Hamm RJ, Pike BR, Temple MD, O’Dell DM, Lyeth BG (1995) The effect of postinjury kindled seizures on cognitive performance of traumatically brain-injured rats. Exp Neurol 136(2):143–148

    Article  CAS  PubMed  Google Scholar 

  40. Willmore LJ (1990) Post-traumatic epilepsy: cellular mechanisms and implications for treatment. Neurology 31(Suppl 3):S67–S73

    Google Scholar 

  41. D’Ambrosio R, Maris DO, Grady MS, Winn HR, Janigro D (1999) Impaired K(+) homeostasis and altered electrophysiological properties of post-traumatic hippocampal glia. J Neurosci 19(18):8152–8162

    PubMed  Google Scholar 

  42. Rzigalinski BA, Weber JT, Williughby KA, Ellis EF (1998) Intracellular free calcium dynamics in stretch-injured astrocytes. J Neurochem 70(6):2377–2385

    Article  PubMed  CAS  Google Scholar 

  43. Yang L, Benardo LS (2000) Valproate prevents epileptiform activity after trauma in an in vitro model in neocortical slices. Epilepsia 41(12):1507–1513

    Article  CAS  PubMed  Google Scholar 

  44. Golarai G, Greenwood AC, Feeney DM, Connor JA (2001) Physiological and structural evidence for hippocampal involvement in persistent seizure susceptibility after traumatic brain injury. J Neurosci 21(21):8523–8537

    PubMed  CAS  Google Scholar 

  45. Bergsneider M, Hovda DA, Shalmon E, Kelly DF, Vespa PM, Martin NA et al (1997) Cerebral hyperglycolysis following severe traumatic brain injury in humans: a positron emission tomography study. J Neurosurg 86(2):241–251

    Article  PubMed  CAS  Google Scholar 

  46. Bullock R, Zauner A, Myseros JS, Marmarou A, Woodward JJ, Young HF (1995) Evidence for prolonged release of excitatory amino acids in severe human head trauma. Relationship to clinical events. Ann N Y Acad Sci 765:290–297

    Article  PubMed  CAS  Google Scholar 

  47. Goodman JC, Valadka AB, Gopinath SP, Cormio M, Robertson CS (1996) Lactate and excitatory amino acids measured by microdialysis are decreased by pentobarbital coma in head-injured patients. J Neurotrauma 13(10):549–556

    PubMed  CAS  Google Scholar 

  48. Nilsson P, Hillered L, Olsson Y, Sheardown MJ, Hansen AJ (1993) Regional changes in interstitial K+ and Ca2+ levels following cortical compression contusion trauma in rats. J Cereb Blood Flow Metab 13(2):183–192

    Article  PubMed  CAS  Google Scholar 

  49. DeWitt DS, Prough DS, Taylor CL, Whitley JM (1992) Reduced cerebral blood flow, oxygen delivery, and electroencephalographic activity after traumatic brain injury and mild hemorrhage in cats. J Neurosurg 76(5):812–821

    Article  PubMed  CAS  Google Scholar 

  50. McKinney RA, Debanne D, Gahwiler BH, Thompson SM (1997) Lesion-induced axonal sprouting and hyperexcitability in the hippocampus in vitro: implications for the genesis of posttraumatic epilepsy. Nat Med 3(9):990–996

    Article  PubMed  CAS  Google Scholar 

  51. Ballanyi K, Grafe P, ten Bruggencate G (1987) Ion activities and potassium uptake mechanisms of glial cells in guinea- pig olfactory cortex slices. J Physiol 382:159–174

    PubMed  CAS  PubMed Central  Google Scholar 

  52. Janigro D, Gasparini S, D’Ambrosio R, McKhann G, DiFrancesco D (1997) Reduction of K+ uptake in glia prevents long-term depression maintenance and causes epileptiform activity. J Neurosci 17(8):2813–2824

    PubMed  CAS  Google Scholar 

  53. Carlson H, Ronne-Engstrom E, Ungerstedt U, Hillered L (1992) Seizure related elevations of extracellular amino acids in human focal epilepsy. Neurosci Lett 140(1):30–32

    Article  PubMed  CAS  Google Scholar 

  54. Vespa P, Martin NA, Nenov V, Glenn T, Bergsneider M, Kelly D et al (2002) Delayed increase in extracellular glycerol with post-traumatic electrographic epileptic activity: support for the theory that seizures induce secondary injury. Acta Neurochir Suppl 81:355–357

    PubMed  CAS  Google Scholar 

  55. Duncan R (1992) Epilepsy, cerebral blood flow, and cerebral metabolic rate. Cerebrovasc Brain Metab Rev 4(2):105–121

    PubMed  CAS  Google Scholar 

  56. Bazan NG, Tu B, Rodriguez de Turco EB (2002) What synaptic lipid signaling tells us about seizure-induced damage and epileptogenesis. Prog Brain Res 135:175–185

    Article  PubMed  CAS  Google Scholar 

  57. Doi T, Ueda Y, Tokumaru J, Mitsuyama Y, Willmore LJ (2001) Sequential changes in AMPA and NMDA protein levels during Fe(3+)- induced epileptogenesis. Brain Res Mol B

    Google Scholar 

  58. Samuelsson C, Kumlien E, Flink R, Lindholm D, Ronne-Engstrom E (2000) Decreased cortical levels of astrocytic glutamate transport protein GLT- 1 in a rat model of posttraumatic epilepsy. Neurosci Lett 289(3):185–188

    Article  PubMed  CAS  Google Scholar 

  59. Ben Ari Y (2001) Cell death and synaptic reorganizations produced by seizures. Epilepsia 42(Suppl 3):5–7

    Article  PubMed  Google Scholar 

  60. Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM et al (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34(2):216–222

    Article  PubMed  CAS  Google Scholar 

  61. Dawson RE, Webster JE, Gurdjian ES (1951) Serial electroencephalography in acute head injuries. J Neurosurg 8:613–630

    Article  PubMed  CAS  Google Scholar 

  62. Bricolo A, Turazzi S, Faccioli F, Odorizzi F, Sciaretta G, Erculiani P (1978) Clinical application of compressed spectral array in long-term EEG monitoring of comatose patients. Electroencephalogr Clin Neurophysiol 45(2):211–225

    Article  PubMed  CAS  Google Scholar 

  63. Hutchinson DO, Frith RW, Shaw NA, Judson JA, Cant BR (1991) A comparison between electroencephalography and somatosensory evoked potentials for outcome prediction following severe head injury. Electroencephalogr Clin Neurophysiol 78(3):228–233

    Article  PubMed  CAS  Google Scholar 

  64. Rumpl E, Lorenzi E, Hackl JM, Gerstenbrand F, Hengl W (1979) The EEG at different stages of acute secondary traumatic midbrain and bulbar brain syndromes. Electroencephalogr Clin Neurophysiol 46(5):487–497

    Article  PubMed  CAS  Google Scholar 

  65. Synek VM (1990) Revised EEG coma scale in diffuse acute head injuries in adults. Clin Exp Neurol 27:99–111

    PubMed  CAS  Google Scholar 

  66. Hari R, Sulkava R, Haltia M (1982) Brainstem auditory evoked responses and alpha-pattern coma. Ann Neurol 11(2):187–189

    Article  PubMed  CAS  Google Scholar 

  67. Obeso JA, Iragui MI, Marti-Masso JF, Maravi E, Teijeira JM, Carrera N et al (1980) Neurophysiological assessment of alpha pattern coma. J Neurol Neurosurg Psychiatry 43(1):63–67

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  68. Stockard JJ, Bickford RG, Aung MH (1975) The electroencephalogram in traumatic brain injury. In: Vinken RJ, Bruyn GW (eds) Handbook of clinical neurology. Elsevier, Amsterdam, pp 317–367

    Google Scholar 

  69. Westmoreland BF, Klass DW, Sharbrough FW, Reagan TJ (1975) Alpha-coma. Electroencephalographic, clinical, pathologic, and etiologic correlations. Arch Neurol 32(11):713–718

    Article  PubMed  CAS  Google Scholar 

  70. Sironi VA, Ravagnati L, Signoroni G (1982) Diagnostic and prognostic value of EEG compressed spectral analysis in post-traumatic coma. In: Villani R, Papo I, Giovanelli M (eds) Advances in neurotraumatology. Excerpta Medica, Amsterdam, pp 328–330

    Google Scholar 

  71. Cant BR, Shaw NA (1984) Monitoring by compressed spectral array in prolonged coma. Neurology 34(1):35–39

    Article  PubMed  CAS  Google Scholar 

  72. Steudel WI, Kruger J (1979) Using the spectral analysis of the EEG for prognosis of severe brain injuries in the first post-traumatic week. Acta Neurochir Suppl (Wien) 28(1):40–42

    CAS  Google Scholar 

  73. Varelas PN, Spanaki MV, Hacein-Bey L, Hether T, Terranova B (2003) Emergent EEG: indications and diagnostic yield. Neurology 61(5):702–704

    Article  PubMed  CAS  Google Scholar 

  74. McQueen JK, Blackwood DH, Harris P, Kalbag RM, Johnson AL (1983) Low risk of late post-traumatic seizures following severe head injury: implications for clinical trials of prophylaxis. J Neurol Neurosurg Psychiatry 46(10):899–904

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  75. Haltiner AM, Newell DW, Temkin NR, Dikmen SS, Winn HR (1999) Side effects and mortality associated with use of phenytoin for early posttraumatic seizure prophylaxis. J Neurosurg 91(4):588–592

    Article  PubMed  CAS  Google Scholar 

  76. Pechadre JC, Lauxerois M, Colnet G, Commun C, Dimicoli C, Bonnard M et al (1991) [Prevention of late post-traumatic epilepsy by phenytoin in severe brain injuries. 2 years’ follow-up]. Presse Med 20(18):841–845

    PubMed  CAS  Google Scholar 

  77. Glotzner FL, Haubitz I, Miltner F, Kapp G, Pflughaupt KW (1983) Seizure prevention using carbamazepine following severe brain injuries. Neurochirurgia (Stuttg) 26(3):66–79

    CAS  Google Scholar 

  78. Temkin NR, Dikmen SS, Anderson GD, Wilensky AJ, Holmes MD, Cohen W et al (1999) Valproate therapy for prevention of posttraumatic seizures: a randomized trial. J Neurosurg 91(4):593–600

    Article  PubMed  CAS  Google Scholar 

  79. Manaka S (1992) Cooperative prospective study on posttraumatic epilepsy: risk factors and the effect of prophylactic anticonvulsant. Jpn J Psychiatry Neurol 46(2):311–315

    PubMed  CAS  Google Scholar 

  80. Jones KE, Puccio AM, Harshman KJ, Falcione B, Benedict N, Jankowitz BT et al (2008) Levetiracetam versus phenytoin for seizure prophylaxis in severe traumatic brain injury. Neurosurg Focus 25(4):E3

    Article  PubMed  PubMed Central  Google Scholar 

  81. Chang BS, Lowenstein DH (2003) Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 60(1):10–16

    Article  PubMed  Google Scholar 

  82. The Brain Trauma Foundation, The American Association of Neurological Surgeons, Congress of Neurological Surgeons, The Joint Section on Neurotrauma and Critical Care (2007) Guidelines for the management of severe traumatic brain injury. XIII Antiseizure prophylaxis. J Neurotrauma 24(Suppl 1):S83–S86

    Google Scholar 

  83. Young B, Rapp RP, Norton JA, Haack D, Tibbs PA, Bean JR (1983) Failure of prophylactically administered phenytoin to prevent late posttraumatic seizures. J Neurosurg 58(2):236–241

    Article  PubMed  CAS  Google Scholar 

  84. Schierhout G, Roberts I (1998) Prophylactic antiepileptic agents after head injury: a systematic review. J Neurol Neurosurg Psychiatry 64(1):108–112

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  85. Hernandez TD (1997) Preventing post-traumatic epilepsy after brain injury: weighing the costs and benefits of anticonvulsant prophylaxis. Trends Pharmacol Sci 18(2):59–62

    Article  PubMed  CAS  Google Scholar 

  86. Young B, Rapp RP, Norton JA, Haack D, Tibbs PA, Bean JR (1983) Failure of prophylactically administered phenytoin to prevent early posttraumatic seizures. J Neurosurg 58(2):231–235

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Neurosurgery, Aspirus Spine and Neuroscience Institute, Aspirus Wausau Hospital, Wausau, WI, USA

    Andrew Beaumont

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  1. Dept. Neurology, Henry Ford Hospital, W. Grand Blvd. 2799 , Detroit, 48202-2689, U.S.A.

    Panayiotis Varelas

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Beaumont, A. (2010). Traumatic Brain Injury and Seizures in the ICU. In: Varelas, P. (eds) Seizures in Critical Care. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-532-3_4

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