Abstract
Posttraumatic epilepsy (PTE) is a recognized sequela of traumatic brain injury (TBI), but the long-term outcomes associated with PTE independent of injury severity are not precisely known. To determine the incidence, risk factors, and association with functional outcomes and self-reported somatic, cognitive, and psychological concerns of self-reported PTE in a large, prospectively collected TBI cohort. This multicenter, prospective cohort study was conducted as part of the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study and identified patients presenting with TBI to 1 of 18 participating level 1 US trauma centers from February 2014 to July 2018. Patients with TBI, extracranial orthopedic injuries (orthopedic controls), and individuals without reported injuries (eg, friends and family of participants; hereafter friend controls) were prospectively followed for 12 months. Data were analyzed from January 2020 to April 2021. Demographic, imaging, and clinical information was collected according to TBI Common Data Elements. Incidence of self-reported PTE was assessed using the National Institute of Neurological Disorders and Stroke Epilepsy Screening Questionnaire (NINDS-ESQ). Primary outcomes included Glasgow Outcome Scale Extended, Rivermead Cognitive Metric (RCM; derived from the Rivermead Post Concussion Symptoms Questionnaire), and the Brief Symptom Inventory-18 (BSI). Of 3296 participants identified as part of the study, 3044 met inclusion criteria, and 1885 participants (mean [SD] age, 41.3 [17.1] years; 1241 [65.8%] men and 644 [34.2%] women) had follow-up information at 12 months, including 1493 patients with TBI; 182 orthopedic controls, 210 uninjured friend controls; 41 patients with TBI (2.8%) and no controls had positive screening results for PTE. Compared with a negative screening result for PTE, having a positive screening result for PTE was associated with presenting Glasgow Coma Scale score (8.1 [4.8] vs.13.5 [3.3]; P < .001) as well as with anomalous acute head imaging findings (risk ratio, 6.42 [95% CI, 2.71-15.22]). After controlling for age, initial Glasgow Coma Scale score, and imaging findings, compared with patients with TBI and without PTE, patients with TBI and with positive PTE screening results had significantly lower Glasgow Outcome Scale Extended scores (mean [SD], 6.1 [1.7] vs 4.7 [1.5]; P < .001), higher BSI scores (mean [SD], 50.2 [10.7] vs 58.6 [10.8]; P = .02), and higher RCM scores (mean [SD], 3.1 [2.6] vs 5.3 [1.9]; P = .002) at 12 months. In this cohort study, the incidence of self-reported PTE after TBI was found to be 2.8% and was independently associated with unfavorable outcomes. These findings highlight the need for effective antiepileptogenic therapies after TBI.
Highlights
Traumatic brain injuries (TBI) are among the most common maladies affecting humanity.[1]
Downloaded From: https://jamanetwork.com/ on 02/28/2022. In this cohort study, the incidence of self-reported posttraumatic epilepsy (PTE) after traumatic brain injury (TBI) was found to be 2.8% and was independently associated with unfavorable outcomes. These findings highlight the need for effective antiepileptogenic therapies after TBI
After controlling for age, initial Glasgow Coma Scale score, and imaging findings, compared with patients with TBI and without PTE, patients with TBI and with positive PTE screening results had significantly lower Glasgow Outcome Scale Extended scores, higher Brief Symptom Inventory-18 (BSI) scores, and higher Rivermead Cognitive Metric (RCM) scores at 12 months. This cohort study reports on the initial validation of the Neurological Disorders and Stroke (NINDS)-Epilepsy Screening Questionnaire (ESQ) in the TRACK-TBI cohort, confirms that the risk factors for PTE and the overall incidence were comparable with what has been reported in previous studies, and takes advantage of the large, prospectively collected cohort to investigate the associations of self-reported PTE with poor functional outcomes and persistent posttraumatic symptoms
Summary
Traumatic brain injuries (TBI) are among the most common maladies affecting humanity.[1]. Previous studies have examined the incidence and sequelae of PTE, there are still several open questions that remain to be resolved. The prevalence of PTE after mild TBI (Glasgow Coma Scale [GCS] score, 13-15) has not been addressed in a recent, prospective database, to our knowledge. Of the 2 previous studies large enough to examine PTE after mild injuries, one was in the pre–computed tomography (CT) era,[7] and the other used an administrative database.[8,9] Second, previous studies of PTE have not been performed using prospectively collected granular data, limiting the risk factors and outcomes that can be statistically associated with the development of PTE. It has been reported that patients with PTE exhibit reduced mental health outcomes after TBI.[9,10] prospective data regarding the incidence and risk factors of PTE exist,[11] relatively few studies investigate how PTE is associated with overall outcomes after TBI
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