Nghiên cứu đặc điểm lâm sàng, cận lâm sàng và đánh giá kết quả điều trị ở bệnh nhân động kinh sau chấn thương sọ não

Abstract

Background: Post-traumatic epilepsy (PTE) results in a huge burden and reduces patients' quality of life. Understanding clinical, subclinical characteristics and assessing treatment results helps to improve management strategies for epilepsy after traumatic brain injury (TBI). Objectives: 1. To describe clinical and subclinical characteristics of patients with PTE at Vietnam - Cuba Friendship Dong Hoi Hospital. 2. To evaluate initial results of the treatment of PTE after 3 months. Methods: A cross-sectional descriptive study with follow-up on 58 patients with PTE receiving examination and treatment at Vietnam - Cuba Friendship Dong Hoi Hospital from April 2022 to June 2023. Results: Clinical: Late PTE (occurring > 1 week after TBI) accounted for 69% with 6.9% of first seizures occurred from 1 week - 6 months after TBI while 3.4% happened between 6 months - 1 year. Most seizures lasting less than 5 minutes (86.2%); 37.9% had ³ 1 seizure per month; 32.8% had 1 seizure weekly and daily attacks accounted for 24.1%. Focal seizure registered the majority (89.6%) while generalized seizures accounted for 10.4%; there was a difference in type of seizure between early PTE and late PTE. Subclinical: Abnormal electroencephalogram (EEG) was recorded in 24.1% of cases with following characteristics: diffuse slowing in both hemispheres (6.9%), localized slow waves (17.2%). Lesion location on CT/MRI: temple 53.4% and forehead 46.6%. Treatment results: 87.9% of TBI cases were treated conservatively and 12.1% were treated surgically. Antiepileptic medications: Depakin (62.5%), Tegretol (13.8%), Phenytoin (13.8%), Keppra (8.6%); treatment adherence rate was very high (89.7%). The recurrence rate was 37.9%, this was lower in the group of early PTE compared with late PTE (22.2% versus 45%). During 3 months of treatment, the majority had 1 - 4 seizures (72.2%) and 19.0% needed re-hospitalization. Neurological complications were recorded in 12.1% of cases. Aura happened in 43.1% of cases, more frequently in late PTE when compared with early PTE (50.0% and 27.8%, respectively). Conclusion: Prophylaxis of PTE should be considered in TBI patients having seizures without EEG abnormalities or in elderly patients with temporal and frontal lobe lesions.