A population-based study of risk of epilepsy after hospitalization for traumatic brain injury. Epilepsia

Department of Medicine, Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston, South California 29425, USA.
Epilepsia (Impact Factor: 4.58). 10/2009; 51(5):891-8. DOI: 10.1111/j.1528-1167.2009.02384.x
Source: PubMed

ABSTRACT This study was undertaken to determine the risk of developing posttraumatic epilepsy (PTE) within 3 years after discharge among a population-based sample of older adolescents and adults hospitalized with traumatic brain injury (TBI) in South Carolina. It also identifies characteristics related to development of PTE within this population.
A stratified random sample of persons aged 15 and older with TBI was selected from the South Carolina nonfederal hospital discharge dataset for four consecutive years. Medical records of recruits were reviewed, and they participated in up to three yearly follow-up telephone interviews.
The cumulative incidence of PTE in the first 3 years after discharge, after adjusting for loss to follow-up, was 4.4 per 100 persons over 3 years for hospitalized mild TBI, 7.6 for moderate, and 13.6 for severe. Those with severe TBI, posttraumatic seizures prior to discharge, and a history of depression were most at risk for PTE. This higher risk group also included persons with three or more chronic medical conditions at discharge.
These results raise the possibility that although some of the characteristics related to development of PTE are nonmodifiable, other factors, such as depression, might be altered with intervention. Further research into factors associated with developing PTE could lead to risk-reducing treatments.

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Available from: Anbesaw W Selassie, Oct 13, 2014
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    • "Epilepsy is a well-documented sequel to traumatic brain injury (TBI) [1] [2] [3] [4] [5] [6] [7] [8] [9] [10]. However, epilepsy can lead to TBI; the incidence of epilepsyinduced TBI depends on the type of epilepsy and the degree of seizure control [11] [12] [13] [14]. "
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    ABSTRACT: While traumatic brain injury (TBI) can lead to epilepsy, individuals with preexisting epilepsy or seizure disorder (ESD), depending on the type of epilepsy and the degree of seizure control, may have a greater risk of TBI from seizure activity or medication side effects. The joint occurrence of ESD and TBI can complicate recovery as signs and symptoms of TBI may be mistaken for postictal effects. Those with ESD are predicted to experience more deleterious outcomes either because of having a more severe TBI or because of the cumulative effects of repetitive TBI. We conducted a case-control study of all emergency department visits and hospital discharges for TBI from 1998 through 2011 in a statewide population. The severity of TBI, repetitive TBI, and other demographic and clinical characteristics were compared between persons with TBI with preexisting ESD (cases) and those without (controls). Significant differences in proportions were evaluated with confidence intervals. Logistic regression was used to examine the association of the independent variables with ESD. During the study period, 236,164 individuals sustained TBI, 5646 (2.4%) of which had preexisting ESD. After adjustment for demographic and clinical characteristics, cases were more likely to have sustained a severe TBI (OR=1.49; 95% CI=1.38-1.60) and have had repetitive TBI (OR=1.54; 95% CI=1.41-1.69). The consequences of TBI may be greater in individuals with ESD owing to the potential for a more severe or repetitive TBI. Seizure control is paramount, and aggressive management of comorbid conditions among persons with ESD and increased awareness of the hazard of repetitive TBI is warranted. Furthermore, future studies are needed to examine the long-term outcomes of cases in comparison with controls to determine if the higher risk of severe or repetitive TBI translates into permanent deficits.
    Epilepsy & Behavior 01/2014; 32C:42-48. DOI:10.1016/j.yebeh.2013.12.035 · 2.06 Impact Factor
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    • "Data regarding the incidence rate of VS in different countries show a range of 14 to 67 individuals per million population at one month after brain injury [5], while the incidence rate of MCS is believed to be greater [4]. Epileptic seizures (ESs) are a common occurrence in patients who have suffered from an acute brain injury, and these may appear after a traumatic brain injury, stroke, or cerebral hypoxia [6] [7] [8] [9]. Epileptic seizures can be classified as acute symptomatic seizures (i.e., in close temporal correlation with the brain injury) [10], or they can be due to a structural epilepsy (i.e., induced by structural changes in the brain after the injury) [11]. "
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    ABSTRACT: Since most antiepileptic drugs (AEDs) have cognitive effects, the aim of this study was to evaluate the influence of AED therapy on the recovery of consciousness in 103 consecutive patients in a vegetative or minimally conscious state (VS, MCS). The levels of cognitive functioning (LCF) score was retrospectively compared after a three-month period of rehabilitation between patients who were medicated (n=54) and patients who were not medicated (n=49) with AEDs. Mean LCF scores in AED-medicated and nonmedicated patients were 2.2±0.7 and 2.3±0.8 at admission and 3.8±2.2 and 3.7±2.1 after three months, respectively (p values>0.05). These results did not change when we compared patients with the same etiology separately, with the same disorder of consciousness only, or patients treated with only one or more than one AED. In conclusion, AEDs did not affect the recovery of consciousness in a large cohort of patients in a VS or MCS following an acute brain injury.
    Epilepsy & Behavior 03/2013; 27(2):365-370. DOI:10.1016/j.yebeh.2013.02.005 · 2.06 Impact Factor
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    • "In extreme cases of 81 aggression, where others are at risk of harm, physical interventions including restraint may be used 82 which can result in injury [8]. There is increased risk for epilepsy among people with TBI, and risk 83 for epilepsy increases with the severity of the TBI [9]. People with epilepsy are two to six times 84 more likely to sustain a fracture than the general population [10] in part due to seizure related falls, 85 physical problems such as weakness and loss of balance. "
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    ABSTRACT: BACKGROUND: Osteoporosis is characterised by low bone mineral density (BMD) leading to an increased risk of fracture. Patients who have sustained a significant traumatic brain injury may have an increased risk of secondary reduced BMD as a result of immobility and other factors. OBJECTIVES: To describe BMD in a cohort of patients recovering from traumatic brain injury, and to discuss the implications of the findings for physiotherapy practice. DESIGN: Prospective, observational. SETTING: Specialist, residential unit providing care for individuals with brain injury, many with a history of severe challenging behaviour. PARTICIPANTS: Current inpatients (n=51, 80% male) with the capacity to provide consent, as judged by their responsible clinician. The median age was 41 years (range 20 to 60 years), and the median time since the brain injury was sustained was 22 years (range 4 to 54 years). METHODS: Participants' BMD was measured at the radius and tibia using quantitative ultrasound. Various clinical and demographic details were collected. RESULTS: Participants had suboptimal BMD measurements that were generally low for their age and gender. Nine (18%) participants met the criteria for osteopenia measured at the radius, and 26 (51%) participants met criteria for osteoporosis or osteopenia measured at the tibia. CONCLUSIONS: Some participants had reduced BMD, putting them at risk of fracture or of developing such risk in the future. This group is at particular risk because they frequently display challenging aggressive behaviours that may be met with responses including proportionate use of manual restraint. Physiotherapists should bear this increased risk in mind when devising exercise programmes assessing risk in neurobehavioural rehabilitation settings.
    Physiotherapy 03/2013; 99(4):328-334. DOI:10.1016/ · 2.11 Impact Factor
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