Posttraumatic Epilepsy After Penetrating Head Injury
Posttraumatic Epilepsy After Penetrating Head Injury
In this retrospective study, the authors evaluated confounding risk factors, which are allegedly influential in causing unprovoked posttraumatic epilepsy, in 489 patients from the frontlines of the Iran--Iraq War.
Four hundred eighty-nine patients were followed for 6 to154 months (mean 39.4 months, median 23 months), and important factors precipitating posttraumatic epilepsy were evaluated using uni- and multivariate regression analysis.
One hundred fifty-seven (32%) of 489 patients became epileptic during the study period. The results of univariate analysis indicated a significant relationship between epilepsy and Glasgow Outcome Scale (GOS) score (X = 76.49, p < 0.0001, df = 2), Glasgow Coma Scale score at admission (X = 19.48, p < 0.0001, df = 3), motor deficit (X = 11.79, p < 0.001, df = 1), mode of injury (X = 10.731, p < 0.05), transventricular injury (X = 6.9, p < 0.008, df = 1), dysphasia (X = 5.3, p < 0.02), central nervous system infections (X = 5.3, p < 0.02), and early-onset seizures (X = 4.1, p < 0.04, df = 1). The results of multivariate analysis, on the other hand, indicated that the GOS score and motor deficit were of greater statistical importance (X = 35.24, p < 0.0001; and X = 7.1, p < 0.07, respectively). Factors that did have much statistically significant bearing on posttraumatic epilepsy were the projectile type, site of injury on the skull, patient age, number of affected lobes, related hemorrhagic complications, and retained metallic or bone fragments.
Glasgow Outcome Scale score and focal motor neurological deficit are of particular importance in predicting posttraumatic epilepsy after missile head injury.
Each year nearly half a million people are involved in some kind of accidental brain injury, and 80,000 of them require hospitalization due to moderate to severe TBI. Mortality and morbidity as a consequence of TBI are a major public health problem. Posttraumatic epilepsy is linked to psychosocial disability and is probably a contributing factor to premature death after penetrating head injury. Almost 50% of victims of penetrating head trauma enrolled in military series become epileptic. The exact pathophysiology of PTE after closed or penetrating head injury is not known. Analysis of some evidence suggests that iron could play a role in the pathogenesis of the seizure focus. Recent data indicate that although phenytoin and valproate are capable of reducing the incidence of early posttraumatic seizures, they are incapable of preventing late-onset PTE. Many confounding risk factors, such as retained metal fragments, the extent and site of injury, level of consciousness, residual focal deficit, and complications have been studied to pinpoint the importance of each in efforts to clarify the pathophysiological mechanisms of PTE and therefore prophylaxis. In this study we attempted to bring greater clarity to the rank of different confounding variables in a multivariate regression model.
In this retrospective study, the authors evaluated confounding risk factors, which are allegedly influential in causing unprovoked posttraumatic epilepsy, in 489 patients from the frontlines of the Iran--Iraq War.
Four hundred eighty-nine patients were followed for 6 to154 months (mean 39.4 months, median 23 months), and important factors precipitating posttraumatic epilepsy were evaluated using uni- and multivariate regression analysis.
One hundred fifty-seven (32%) of 489 patients became epileptic during the study period. The results of univariate analysis indicated a significant relationship between epilepsy and Glasgow Outcome Scale (GOS) score (X = 76.49, p < 0.0001, df = 2), Glasgow Coma Scale score at admission (X = 19.48, p < 0.0001, df = 3), motor deficit (X = 11.79, p < 0.001, df = 1), mode of injury (X = 10.731, p < 0.05), transventricular injury (X = 6.9, p < 0.008, df = 1), dysphasia (X = 5.3, p < 0.02), central nervous system infections (X = 5.3, p < 0.02), and early-onset seizures (X = 4.1, p < 0.04, df = 1). The results of multivariate analysis, on the other hand, indicated that the GOS score and motor deficit were of greater statistical importance (X = 35.24, p < 0.0001; and X = 7.1, p < 0.07, respectively). Factors that did have much statistically significant bearing on posttraumatic epilepsy were the projectile type, site of injury on the skull, patient age, number of affected lobes, related hemorrhagic complications, and retained metallic or bone fragments.
Glasgow Outcome Scale score and focal motor neurological deficit are of particular importance in predicting posttraumatic epilepsy after missile head injury.
Each year nearly half a million people are involved in some kind of accidental brain injury, and 80,000 of them require hospitalization due to moderate to severe TBI. Mortality and morbidity as a consequence of TBI are a major public health problem. Posttraumatic epilepsy is linked to psychosocial disability and is probably a contributing factor to premature death after penetrating head injury. Almost 50% of victims of penetrating head trauma enrolled in military series become epileptic. The exact pathophysiology of PTE after closed or penetrating head injury is not known. Analysis of some evidence suggests that iron could play a role in the pathogenesis of the seizure focus. Recent data indicate that although phenytoin and valproate are capable of reducing the incidence of early posttraumatic seizures, they are incapable of preventing late-onset PTE. Many confounding risk factors, such as retained metal fragments, the extent and site of injury, level of consciousness, residual focal deficit, and complications have been studied to pinpoint the importance of each in efforts to clarify the pathophysiological mechanisms of PTE and therefore prophylaxis. In this study we attempted to bring greater clarity to the rank of different confounding variables in a multivariate regression model.
