Citation

Pease M, Mallela AN, Elmer J, Okonkwo DO, Shutter L, Barot N, Gonzalez-Martinez J, Castellano JF. Neurology 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Lippincott Williams and Wilkins)

DOI

10.1212/WNL.0000000000207183

PMID

36948595

Abstract

OBJECTIVE: Nearly one-third of severe traumatic brain injury (TBI) patients develop post-traumatic epilepsy (PTE). The relationship between PTE and long-term outcomes is unknown. We tested if, after controlling for injury severity and age, PTE is associated with worse functional outcomes after severe TBI.

METHODS: We performed a retrospective analysis of a prospective database of severe TBI patients treated from 2002 through 2018 at a single level 1 trauma center. Glasgow Outcome Scale (GOS) was collected at 3-, 6-, 12-, and 24-months post-injury. We used repeated measures logistic regression predicting GOS, dichotomized as favorable (GOS 4-5) versus unfavorable (GOS 1-3), and a separate logistic model predicting mortality at two years. We used predictors as defined by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) base model (i.e., age, pupil reactivity, and GCS motor score), PTE status, and time.

RESULTS: Of 392 patients who survived to discharge, 98 (25%) developed PTE. The proportion of patients with favorable outcomes at 3-months did not differ between those with and without PTE (23% [95% Confidence Interval [CI]: 15%-34%] vs. 32% [95% CI: 27%-39%]; p=0.11), but was significantly lower at 6- (33% [95% CI: 23-44%] vs. 46%; [95% CI: 39-52%] p=0.03), 12- (41% [95% CI: 30-52%] vs. 54% [95% CI: 47-61%]; p=0.03), and 24-months (40% [95% CI: 47-61%] vs. 55% [95% CI: 47-63%]; p=0.04). This was driven by higher rates of GOS 2 (vegetative) and 3 (severe disability) outcomes in the PTE group. By two years, the incidence of GOS 2 or 3 was double in the PTE group (46% [95% CI: 34-59%]) compared to non-PTE group (21% [95% CI: 16-28%]; p<0.001), while mortality was similar (14% [95% CI: 7-25%] vs. 23% [95% CI: 17-30%]; p=0.28). In multivariate analysis, patients with PTE had lower odds of favorable outcome (odds radio [OR] 0.1; 95% CI: 0.1-0.4; p<0.001), but not mortality (OR 0.9; 95% CI: 0.1-1.9; p=0.46).

INTERPRETATION: Post-traumatic epilepsy is associated with impaired recovery from severe TBI and poor functional outcomes. Early screening and treatment of PTE may improve patient outcomes.

Language: en