Abstract
Post-traumatic seizures (PTS) are a common and debilitating complication of traumatic brain injury (TBI) and could have a harmful impact on the progress of patient rehabilitation. To assess the effect of PTS and relative therapy on outcome in the initial phase after TBI, during the rehabilitation process when neuroplasticity is at its highest, we retrospectively examined the clinical data of 341 adult patients undergoing rehabilitation for at least 6 months post-TBI in our neurorehabilitation unit between 2008 and 2019. We correlated through logistic regression the occurrence of seizures and use of anti-seizure medication (ASM) with neurological and functional outcomes, respectively assessed with the Glasgow Coma Scale (GCS) and the Functional Independence Measure (FIM). PTS were documented in 19.4% of patients: early PTS (EPTS) in 7.0%; late PTS (LPTS) in 9.4%; both types in 3.0%. Patients who developed EPTS had an increased risk of developing LPTS (OR = 3.90, CI 95% 1.58–9.63, p = 0.003). Patients with LPTS had a significantly higher risk of worse neurological (p < 0.0001) and rehabilitation (p < 0.05) outcome. Overall, 38.7% of patients underwent therapy with ASM; prophylactic therapy was prescribed in 24.0% of patients, of whom 14.6% subsequently developed seizures. Mortality was associated with a lower FIM and GCS score on admission but not significantly with PTS. The use of ASM was associated with a worse rehabilitation outcome, independently of the onset of epilepsy during treatment. LPTS appear to exert a negative impact on rehabilitation outcome and their occurrence is not reduced by prophylactic therapy, whereas EPTS do not influence outcome. Our findings caution against the generic use of prophylactic therapy to prevent post-traumatic epilepsy in patients with TBI.
Highlights
Post-traumatic seizures (PTS) are a common and debilitating complication of traumatic brain injury (TBI) and could have a harmful impact on the progress of patient rehabilitation
Our results showed that the use of anti-seizure medication (ASM), either as a prophylactic or for crisis therapy, regardless of the onset of epilepsy during treatment, was associated with a significantly worse Functional Independence Measure (FIM) (Table 5)
We evaluated the impact of PTS and relative antiepileptic therapy on neurological and functional outcomes in a large sample of adult patients undergoing rehabilitation after mild to severe TBI and followed for up to 6 months after injury
Summary
Post-traumatic seizures (PTS) are a common and debilitating complication of traumatic brain injury (TBI) and could have a harmful impact on the progress of patient rehabilitation. Patients surviving the early stages of traumatic brain injury (TBI) usually have a higher risk of developing disabilities and comorbidities later in life, and TBI has a severe impact on their life span. In this scenario, posttraumatic seizures (PTS) and post-traumatic epilepsy (PTE) are common and debilitating complications of TBI. In relation to the time-frame of their occurrence, PTS are classified as “early” post-traumatic seizures (EPTS) if they occur within 7 days of the event, and “late” post-traumatic seizures (LPTS) if they occur > 7 days after the event[1,2] This cut-off reflects differences in the causal mechanisms and subsequent seizure r isk[3,4]. EPTS appear to increase morbidity and mortality in the early stages following TBI12,13 as well as the risk of developing PTE14,15
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
