Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study

Anne C Ritter; Amy K Wagner; Anthony Fabio; Mary Jo Pugh; William C Walker; Jerzy P Szaflarski; Ross D Zafonte; Allen W Brown; Flora M Hammond; Tamara Bushnik; Douglas Johnson-Greene; Timothy Shea; Jason W Krellman; Joseph A Rosenthal; Laura E Dreer

doi:10.1111/epi.13582

Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study

Epilepsia. 2016 Dec;57(12):1968-1977. doi: 10.1111/epi.13582. Epub 2016 Oct 14.

Authors

Anne C Ritter^{1

2}, Amy K Wagner^{2

3

4

5}, Anthony Fabio¹, Mary Jo Pugh^{6

7}, William C Walker⁸, Jerzy P Szaflarski⁹, Ross D Zafonte¹⁰, Allen W Brown¹¹, Flora M Hammond^{12

13}, Tamara Bushnik¹⁴, Douglas Johnson-Greene¹⁵, Timothy Shea¹⁶, Jason W Krellman¹⁷, Joseph A Rosenthal¹⁶, Laura E Dreer¹⁸

Affiliations

¹ Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
² Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
³ Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
⁴ Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
⁵ Center for Neuroscience at University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
⁶ South Texas Veterans Health Care System Polytrauma Rehabilitation Center, San Antonio, Texas, U.S.A.
⁷ Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A.
⁸ Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, U.S.A.
⁹ Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
¹⁰ Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
¹¹ Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, U.S.A.
¹² Carolinas Rehabilitation, Charlotte, North Carolina, U.S.A.
¹³ Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
¹⁴ Rusk Rehabilitation, New York University School of Medicine, New York, New York, U.S.A.
¹⁵ Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
¹⁶ Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio, U.S.A.
¹⁷ Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
¹⁸ Departments of Physical Medicine and Rehabilitation and Ophthalmology, The University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.

PMID: 27739577
DOI: 10.1111/epi.13582

Abstract

Objective: Determine incidence of posttraumatic seizure (PTS) following traumatic brain injury (TBI) among individuals with moderate-to-severe TBI requiring rehabilitation and surviving at least 5 years.

Methods: Using the prospective TBI Model Systems National Database, we calculated PTS incidence during acute hospitalization, and at years 1, 2, and 5 postinjury in a continuously followed cohort enrolled from 1989 to 2000 (n = 795). Incidence rates were stratified by risk factors, and adjusted relative risk (RR) was calculated. Late PTS associations with immediate (<24 h), early (24 h-7 day), or late seizures (>7 day) versus no seizure prior to discharge from acute hospitalization was also examined.

Results: PTS incidence during acute hospitalization was highest immediately (<24 h) post-TBI (8.9%). New onset PTS incidence was greatest between discharge from inpatient rehabilitation and year 1 (9.2%). Late PTS cumulative incidence from injury to year 1 was 11.9%, and reached 20.5% by year 5. Immediate/early PTS RR (2.04) was increased for those undergoing surgical evacuation procedures. Late PTS RR was significantly greater for individuals who self-identified as a race other than black/white (year 1 RR = 2.22), and for black individuals (year 5 RR = 3.02) versus white individuals. Late PTS was greater for individuals with subarachnoid hemorrhage (year 1 RR = 2.06) and individuals age 23-32 (year 5 RR = 2.43) and 33-44 (year 5 RR = 3.02). Late PTS RR years 1 and 5 was significantly higher for those undergoing surgical evacuation procedures (RR: 3.05 and 2.72, respectively).

Significance: In this prospective, longitudinal, observational study, PTS incidence was similar to that in studies published previously. Individuals with immediate/late seizures during acute hospitalization have increased late PTS risk. Race, intracranial pathologies, and neurosurgical procedures also influenced PTS RR. Further studies are needed to examine the impact of seizure prophylaxis in high-risk subgroups and to delineate contributors to race/age associations on long-term seizure outcomes.

Keywords: Epidemiology; Epilepsy; Prophylaxis; Relative risk; TBI Model Systems.

Publication types

Multicenter Study
Observational Study
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adolescent
Adult
Age Factors
Brain Injuries, Traumatic / complications*
Cohort Studies
Epilepsy, Post-Traumatic / epidemiology*
Epilepsy, Post-Traumatic / etiology*
Epilepsy, Post-Traumatic / mortality
Epilepsy, Post-Traumatic / rehabilitation
Female
Humans
Incidence
Male
Risk Factors
Statistics, Nonparametric
Young Adult