Early seizures and temporal lobe trauma predict post-traumatic epilepsy: A longitudinal study

NEUROBIOLOGY OF DISEASE

卷:123

Review

Tubiv, Meral A.²²  Lutkenhof, Evan²³  Villablanca, Pablo²⁴  Van Ness, Paul²⁶  Real, Courtney²⁴  Shrestha, Vikesh²⁴  Engel, Jerome, Jr.²⁴  Vespa, Paul M.²⁴  Agoston, Denes¹  Au, Alicia²  Bell, Michael J.³  Bleck, Tom²⁷  Branch, Craig⁴  Blanco, Manuel Buitrago^5,24  Bullock, Ross⁶  Burrows, Brian T.¹⁷  Claassen, Jan⁷  Clarke, Robert²  Cloyd, James⁸  Coles, Lisa⁸  Crawford, Karen⁹  Diaz-Arrastia, Ramon^10,25  Duncan, Dominique⁹  Ellingson, Benjamin^5,24  Engel, Jerome⁵  Foreman, Brandon¹¹  Galanopoulou, Aristea⁴  Olli, Grohn¹³  Harris, Neil⁵  Hartings, Jed¹¹  Lawrence, Hirsch¹²  Hunn, Martin¹⁴  Jette, Nathalie¹⁵  Johnston, Leigh¹⁶  Jones, Nigel¹⁶  Kanner, Andres⁶  McArthur, David^5,24  Monti, Martin⁵  Morokoff, Andrew¹⁶  Moshe, Solomon⁴  Mowrey, Wenzhu⁴  O'Brien, Terence¹⁶  O'Phelan, Kristine⁶  Pitkanen, Asla¹³  Raman, Rema⁹  Robertson, Courtney¹⁸  Rosenthal, Eric¹⁹  Shultz, Sandy¹⁶  Snutch, Terrance²⁰  Staba, Richard⁵  Toga, Arthur⁹  Van Horn, Jack⁹  Vespa, Paul⁵  Willyerd, Frederick¹⁷  Zimmermann, Lara²¹ 

[1] Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA

[2] Univ Pittsburgh, Pittsburgh, PA 15260 USA

[3] Childrens Natl Hlth Syst, Washington, DC USA

[4] Albert Einstein Coll Med, Bronx, NY 10467 USA

[5] Univ Calif Los Angeles, Los Angeles, CA USA

[6] Univ Miami, Miller Sch Med, Coral Gables, FL 33124 USA

[7] Columbia Univ, New York, NY 10027 USA

[8] Regents Univ Minnesota, Minneapolis, MN USA

[9] Univ Southern Calif, Los Angeles, CA 90089 USA

[10] Univ Penn, Philadelphia, PA 19104 USA

[11] Univ Cincinnati, Cincinnati, OH 45221 USA

[12] Yale Univ, New Haven, CT 06520 USA

[13] Univ Eastern, Kuopio, Finland

[14] Alfred Hosp, Melbourne, Vic, Australia

[15] Univ Calgary, Calgary, AB, Canada

[16] Univ Melbourne, Melbourne, Vic, Australia

[17] Phoenix Childrens Hosp, Phoenix, AZ USA

[18] Johns Hopkins Univ, Baltimore, MD 21218 USA

[19] Massachusetts Gen Hosp, Boston, MA 02114 USA

[20] Univ British Columbia, Vancouver, BC, Canada

[21] Univ Calif Davis, Davis, CA 95616 USA

[22] USC Keck Sch Med, Mark & Mary Stevens Neuroimaging & Informat Inst, Imaging Genet Ctr, Los Angeles, CA USA

[23] Univ Calif Los Angeles, Dept Psychol, Los Angeles, CA 90024 USA

[24] Univ Calif Los Angeles, David Geffen Sch Med, 757 Westwood Blvd,RR 6236A, Los Angeles, CA 90095 USA

[25] Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA

[26] Baylor Coll Med, Dept Neurol & Neurophysiol, Houston, TX 77030 USA

[27] Rush Univ, Med Ctr, Chicago, IL 60612 USA

关键词: Brain trauma;    Post-traumatic epilepsy;    Coma;    Seizures;    Brain atrophy;    Status epilepticus;   

DOI  :  10.1016/j.nbd.2018.05.014

来源: Elsevier

【 摘 要 】

Objective: Injury severity after traumatic brain injury (TBI) is a well-established risk factor for the development of post-traumatic epilepsy (PTE). However, whether lesion location influences the susceptibility of seizures and development of PTE longitudinally has yet to be defined. We hypothesized that lesion location, specifically in the temporal lobe, would be associated with an increased incidence of both early seizures and PTE. As secondary analysis measures, we assessed the degree of brain atrophy and functional recovery, and performed a between group analysis, comparing patients who developed PTE with those who did not develop PTE. Methods: We assessed early seizure incidence (n = 90) and longitudinal development of PTE (n = 46) in a prospective convenience sample of patients with moderate-severe TBI. Acutely, patients were monitored with prospective cEEG and a high-resolution Magnetic Resonance Imaging (MRI) scan for lesion location classification. Chronically, patients underwent a high-resolution MRI, clinical assessment, and were longitudinally monitored for development of epilepsy for a minimum of 2 years post-injury. Results: Early seizures, occurring within the first week post-injury, occurred in 26.7% of the patients (n = 90). Within the cohort of subjects who had evidence of early seizures (n = 24), 75% had a hemorrhagic temporal lobe injury on admission. For longitudinal analyses (n = 46), 45.7% of patients developed PTE within a minimum of 2 years post-injury. Within the cohort of subjects who developed PTE (n = 21), 85.7% had a hemorrhagic temporal lobe injury on admission and 38.1% had early (convulsive or non-convulsive) seizures on cEEG monitoring during their acute ICU stay. In a between-group analysis, patients with PTE (n = 21) were more likely than patients who did not develop PTE (n = 25) to have a hemorrhagic temporal lobe injury (p < 0.001), worse functional recovery (p = 0.003), and greater temporal lobe atrophy (p = 0.029). Conclusion: Our results indicate that in a cohort of patients with a moderate-severe TBI, 1) lesion location specificity (e.g. the temporal lobe) is related to both a high incidence of early seizures and longitudinal development of PTE, 2) early seizures, whether convulsive or non-convulsive in nature, are associated with an increased risk for PTE development, and 3) patients who develop PTE have greater chronic temporal lobe atrophy and worse functional outcomes, compared to those who do not develop PTE, despite matched injury severity characteristics. This study provides the foundation for a future prospective study focused on elucidating the mechanisms and risk factors for epileptogenesis.

【 授权许可】

Free