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The Incidence of Early Seizures in Non-Severe Traumatic Brain Injury Patients and the Efficacy of Prophylactic Antiepileptic Drugs

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Abstract

The incidence of early seizures (ES) in traumatic brain injury (TBI) ranges between 1 and 7%. However, the incidence of ES after a non-severe TBI (NSTBI) with traumatic hemorrhage (TH) is unknown. Moreover, the data about seizure prophylaxis (SP) in this population remains inconclusive. We aim to determine the incidence of ES in NSTBI and the efficacy of SP. We retrospectively reviewed all adult patients with NSTBI with evidence of a TH on presentation from 2015 to 2018 at Methodist University Hospital in Memphis TN. Patients with history of epilepsy or receiving antiseizure medications (ASM) were excluded. We collected demographic data, the type, severity, and mechanism of injury; the need for neurosurgical intervention (NSI); ES; and SP use. A total of 633 patients met our inclusion criteria; 94.4% had mild TBI; mean age was 70.5 years (SD 16.9); 55.0% were males; and 49.1% had subdural hematoma (SDH). Same level fall was the most common mechanism of injury in 79%. Forty patients (6.3%) had ES. After excluding seizures on presentation, 22 of 310 (7.1%) patients had an ES in the SP group (16 clinical) vs 5 of 310 (1.6%) in the non-prophylaxis group (all clinical) (P = 0.001). Levetiracetam as SP was used in 83.5%. Patients with combined SDH and traumatic subarachnoid hemorrhage or with multicompartment hemorrhage were more likely to have ES than SDH alone (p = 0.02 and 0.001, respectively). NSI was not a predictor for ES in our cohort. The incidence of ES (clinical and electrographic) in NSTBI with TH patients in our cohort is higher than previously reported in those with non-severe TBI. ES were reported more in the SP group, which might indicate a clinical selection bias giving more moderate TBI and multicompartmental hemorrhage patients receiving ASM for SP. However, prospective studies are required to further determine the predictors of ES in non-severe TBI and the effect of ASM for SP on outcomes and reducing ES in NSTBI patients.

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References

  1. Centers for Disease Control and Prevention (2019). Surveillance report of traumatic brain injury-related emergency department visits, hospitalizations, and deaths—United States, 2014. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.

  2. Candy N, Tsimiklis C, Poonnoose S, et al. The use of antiepileptic medication in early post traumatic seizure prophylaxis at a single institution. J Clin Neurosci. 2019;69:198–205. https://doi.org/10.1016/j.jocn.2019.07.066.

    Article  PubMed  Google Scholar 

  3. Wat R, Mammi M, Paredes J, et al. The effectiveness of antiepileptic medications as prophylaxis of early seizure in patients with traumatic brain injury compared with placebo or no treatment: a systematic review and meta-analysis. World Neurosurg. 2019;122:433–40. https://doi.org/10.1016/j.wneu.2018.11.076.

    Article  PubMed  Google Scholar 

  4. Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80:6–15.

    Article  Google Scholar 

  5. Bullock MR, Povlishock JT. Guidelines for the management of severe traumatic brain injury. Editor’s Commentary [published correction appears in J Neurotrauma. 2008 Mar;25(3):276–8]. J Neurotrauma. 2007;24(Suppl 1):2-S1. https://doi.org/10.1089/neu.2007.9998.

    Article  PubMed  Google Scholar 

  6. Kwon SJ, Barletta JF, Hall ST, et al. Lacosamide versus phenytoin for the prevention of early post traumatic seizures. J Crit Care. 2019;50:50–3. https://doi.org/10.1016/j.jcrc.2018.11.010.

    Article  CAS  PubMed  Google Scholar 

  7. Ritter AC, Wagner AK, Fabio A. Incidence and risk factors of posttraumatic seizures following traumatic brain injury: a traumatic Brain Injury Model Systems Study. Epilepsia. 2016;57(12):1968–77. https://doi.org/10.1111/epi.13582.

    Article  PubMed  Google Scholar 

  8. Gul N, Khan SA, Khattak HA, et al. Efficacy of phenytoin in prevention of early posttraumatic seizures. J Ayub Med Coll Abbottabad. 2019;31(2):237–41.

    PubMed  Google Scholar 

  9. Dadas A, Janigro D. Breakdown of blood brain barrier as a mechanism of post-traumatic epilepsy. Neurobiol Dis. 2019;123:20–6. https://doi.org/10.1016/j.nbd.2018.06.022.

    Article  CAS  PubMed  Google Scholar 

  10. Kirmani BF, Mungall D, Ling G. Role of intravenous levetiracetam in seizure prophylaxis of severe traumatic brain injury patients. Front Neurol. 2013;4:170. https://doi.org/10.3389/fneur.2013.00170.

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. Yasser Khorchid

    Present address: Department of Neurology, Geisenger Medical Center, Danville, PA, USA

  2. Juan Goyanes

    Present address: Department of Neurology, Vanderbilt University, Nashville, TN, USA

  3. Abhi Pandhi

    Present address: Endovascular Surgical Neuroradiology, Cleveland Clinic, Cleveland, OH, USA

  4. Aman Deep

    Present address: Department of Neurology, Appalachian Regional Health, Beckley, WV, USA

Authors and Affiliations

  1. Department of Neurology, University of Tennessee Health Science Center, 847 Monroe Ave, Ste 226D, Memphis, TN, 38163, USA

    Rashi Krishnan, Juan Goyanes, Abhi Pandhi, Aman Deep, Igal Mirman, Hallie Kelly, William Mays, E. Jeffrey Metter, Morgan G. Jones, Lucas Elijovich, Marc Malkoff & Khalid Alsherbini

  2. Department of Neurosurgery, University of Tennessee Health Science Center, 847 Monroe Ave, Ste 226D, Memphis, TN, 38163, USA

    Yasser Khorchid, Lucas Elijovich & Khalid Alsherbini

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  1. Rashi Krishnan
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  2. Yasser Khorchid
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  13. Khalid Alsherbini
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Contributions

Rashi Krishnan: UTHSC, Memphis TN; Designed and conceptualized the study, interpreted the data, drafted the manuscript for intellectual content

Yasser Khorchid: UTHSC, Memphis TN; Interpreted the data, revised the manuscript for intellectual content

Juan Goyanes: UTHSC, Memphis TN; Major role in the acquisition of data

Abhi Pandhi: UTHSC, Memphis TN; Major role in the acquisition of data

Aman Deep: UTHSC, Memphis TN; Major role in the acquisition of data

Igal Mirman: UTHSC, Memphis TN; Major role in the acquisition of data

Hallie Kelly: UTHSC, Memphis TN; Major role in the acquisition of data

William Mays: UTHSC, Memphis TN; Major role in the acquisition of data

E. Jeffrey Metter: UTHSC, Memphis TN; Interpreted the data, revised the manuscript for intellectual content

Morgan G Jones: UTHSC, Memphis TN; Interpreted the data, revised the manuscript for intellectual content

Lucas Elijovich: UTHSC, Memphis TN; Interpreted the data, revised the manuscript for intellectual content

Marc Malkoff: UTHSC, Memphis TN; Interpreted the data, revised the manuscript for intellectual content

Khalid Alsherbini: UTHSC, Memphis TN; Designed and conceptualized study, drafted the manuscript for intellectual content

Corresponding author

Correspondence to Khalid Alsherbini.

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The retrospective study is in accordance with the ethical standards.

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The authors declare no competing interests.

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Name of the Institution: Methodist University Hospital, Memphis TN

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Krishnan, R., Khorchid, Y., Goyanes, J. et al. The Incidence of Early Seizures in Non-Severe Traumatic Brain Injury Patients and the Efficacy of Prophylactic Antiepileptic Drugs. SN Compr. Clin. Med. 3, 2256–2259 (2021). https://doi.org/10.1007/s42399-021-01049-1

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  • DOI: https://doi.org/10.1007/s42399-021-01049-1

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