Abstract
Objective: Traumatic brain injury (TBI) is a leading cause of long-term disability. Early onset post-traumatic seizures (PTS) after traumatic injury to the brain is a strong predictor of adverse outcomes in these patients. Our study investigates the role of Keppra in early PTS prophylaxis compared to no treatment, taking into account risk factors including injury severity, seizure history, and anti-epileptic drug (AED) use.Methods: This was a retrospective cohort study based on patient chart data from January 2013 to January 2017 at a level one trauma center in the United States. A t-test was performed with P<0.05 as significant; we utilized a 95% confidence interval (CI) for our findings. Subgroup analysis was performed, with respect to the Glasgow Coma Scale (GCS) score (Group A: Mild GCS=13-15, Keppra N=135, Non-Keppra N=122; Group B: Moderate GCS=9-12, Keppra N=23, Non-Keppra N=19; Group C: Severe GCS= <8, Keppra N=69, Non-Keppra=35).Results: Of 403 patients included in the study, 227 were given Keppra. Demographics between treatment groups were similar. Whole cohort analysis confirmed six patients with PTS, and no significant difference between groups (Keppra N=3, Non-Keppra N=3, OR=0.77, P=0.75, 95% CI=(0.154-3.87)). Subgroup analysis revealed reduction in seizure incidence in Keppra groups A (OR=0.18, P=0.27, 95% CI=(0.008-3.80)) and B (OR=0.82, P=0.92, 95% CI=(0.015-43.7)), but this reduction was not statistically significant. Those with the severe TBI in group C accounted for the majority of seizures (n=4, OR=1.52, P=0.71, 95% CI=(0.15-15.4)). Conclusion: Patients with more severe TBI suffered a higher incidence of early-onset post-traumatic seizures. Data of the cohort as a whole revealed a trend towards a lower seizure incidence in patients who were treated with Keppra prophylaxis. Despite this trend, the decrease in seizure incidence did not reach statistical significance.
Highlights
Traumatic brain injury (TBI) is a leading cause of long-term disability, and an estimated 3.3 to 5.3 million people live with some degree of impairment from TBI in the United States [1]
post-traumatic seizures (PTS) is associated with higher rates of pneumonia, acute respiratory distress syndrome (ARDS), acute renal failure, pulmonary embolism, and increased intracranial pressure (ICP)
Of the 403 patients included in our study, 227 had been given Keppra prophylaxis and 176 did not receive seizure prophylaxis
Summary
Traumatic brain injury (TBI) is a leading cause of long-term disability, and an estimated 3.3 to 5.3 million people live with some degree of impairment from TBI in the United States [1]. Seizures are one of the major sources of impairment after patient endures a TBI. PTS is associated with higher rates of pneumonia, acute respiratory distress syndrome (ARDS), acute renal failure, pulmonary embolism, and increased intracranial pressure (ICP). There is significant overlap in the risk factors for early seizure and many of these complications, the relationship between early PTS and patient outcomes is controversial. Risk of early post-traumatic seizure increases with a Glasgow Coma Scale (GCS) score of ≤ 10; subdural, epidural, or intracranial hematoma; linear or depressed skull fracture; cortical contusion; and age ≤ 65 years [3]
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