Association of post-traumatic epilepsy with outcomes in individuals with severe traumatic brain injury

Minneapolis, MN, March 22, 2023 – Post-traumatic epilepsy (PTE) is associated with impaired recovery from severe traumatic brain injury and poor functional outcomes according to research published online on March 22, 2023 in Neurology®, the medical journal of the American Academy of Neurology, by a team of University of Pittsburgh researchers. Early screening and treatment of PTE may improve patient outcomes.

“Post-traumatic epilepsy is very common, accounting for 20% of symptomatic epilepsy,” says Matthew Pease, MD, the corresponding author on the study. “Post-traumatic epilepsy occurs in nearly one-third of patients with severe traumatic brain injury – those who are put in a coma by their brain injury. In our paper. We showed that post-traumatic epilepsy is an independent risk factor for poor outcomes after severe traumatic brain injury. This may occur because as your brain is attempting to recover from a brain injury, seizures lead to deleterious inflammation and secondary brain damage.”

Researchers performed a retrospective analysis of a prospective database including consecutive patients who had severe TBI and were admitted to a single Level 1 trauma center from 2002 through 2018. Patients, aged 16-80 years old, were enrolled with a post-resuscitation Glasgow Coma Scale of less than or equal to 8.

Research personnel then recorded characteristics including age, pupil reactivity, GCS score and neurosurgical procedures; a trained neuropsychologist at in-person, outpatient follow-up visits at the three-, six-, twelve- and twenty-four-months post-trauma through a structured interview using the Glasgow Outcome Scale, which categorizes the outcomes of patients after TBI.

In the 392 patients that were monitored within the cohort, 98 (25%) of them developed PTE and 77 (79%) of the patients within that quarter had their first seizure within two years of trauma. 73% of that quarter sect of patients experienced seizure recurrence within the study period (two years), but a majority of seizures occurred months to years later in an outpatient setting.

Even though the study doesn’t prove causality, the deleterious effect on traumatic brain injury is biologically plausible. Dr. Pease explains, “Epileptogenic pathways in TBI not only cause spontaneous seizures, but also have the potential to induce CNS inflammation, neurodegeneration and most importantly – further seizures. This self-propagating cycle may explain why severe TBI patients with epilepsy have delayed and decreased recovery after brain injury.”

The research team hopes that early, aggressive epilepsy screening and efficient treatment of severe TBI in patients can lead to improved functional outcomes after brain injury. James F. Castellano, MD, PhD, author, says, “Our results underscore the importance of the prompt identification and management of epilepsy in patients who have suffered traumatic brain injury.”

Early treatment of PTE is a key target when it comes to improving these functional outcomes – with the results of this study, there are now opportunities to run clinical trials that focus on novel medicines that treat epilepsy prior to the development of the disease.

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