Epidemiology of traumatic brain injury-associated epilepsy in western China: An analysis of multicenter data

Abstract

ObjectivesThis study aims to explore the probability of developing posttraumatic epilepsy (PTE) in the following 8 years after traumatic brain injury (TBI), the risk factors associated with PTE and its cumulative prevalence. MethodsThis is a retrospective follow-up study of patients with traumatic brain injury (TBI) discharged from the West China Hospital between January 1, 2011 and December 31, 2017, Chengdu Shang Jin Nan Fu Hospital and Sichuan Provincial People’s Hospital from January 1, 2013 to March 1, 2015. We used forward stepwise method to build the final multivariate cox proportional hazard regression model to obtain estimates of hazard ratio (HR) of PTE and 95% confidence intervals (CI). We also conducted Kaplan–Meier survival analysis to investigate the cumulative prevalence of PTE. ResultsThe cumulative incidence of PTE rose from 6.2% in one year to 10.6% in eight years. There were more male patients in PTE group and generally older. Besides, patients with PTE tended to have abnormal CT scan results. The risk factors of PTE were male (HR = 1.6, 95% CI: 1.1−2.2, P = 0.009), early posttraumatic seizures (HR = 2.9, 95% CI: 2.2−4.1, P < 0.001), TBI severity (moderate TBI: HR = 3.0, 95% CI: 1.8−5.0, P = 0.001; severe TBI: HR = 4.3, 95% CI: 2.3−7.6, P < 0.029), loss of consciousness (LOC) more than 30 min (30 min–24 h: HR = 1.8, 95% CI: 1.02−3.1, P = 0.041; >24 h: HR = 2.4, 95% CI: 1.4−2.4, P = 0.001), subdural hematoma (SDH) (HR = 1.9, 95% CI: 1.4−2.5, P < 0.001), brain contusion sites (frontal–temporal lobe: HR = 2.7, 95% CI: 1.9−3.9, P < 0.001; other sites: HR = 1.5, 95% CI: 1.01−2.3, P = 0.042) and cranial surgery (HR = 1.7, 95% CI: 1.3−2.3, P < 0.001). SignificanceThe probability of developing PTE increased during the study period. In addition, the risk of developing PTE was significantly associated with gender, EPTS, LOC time, SDH, brain contusion sites, surgery and TBI severity. However, further researches may be needed to predict the risk of PTE in combination with quantitative factors.