Early seizures and temporal lobe trauma predict post-traumatic epilepsy

A longitudinal study

EpiBioS4Rx Study Group Investigators

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Injury severity after traumatic brain injury (TBI) is a well-established risk factor for the development of post-traumatic epilepsy (PTE). However, whether lesion location influences the susceptibility of seizures and development of PTE longitudinally has yet to be defined. We hypothesized that lesion location, specifically in the temporal lobe, would be associated with an increased incidence of both early seizures and PTE. As secondary analysis measures, we assessed the degree of brain atrophy and functional recovery, and performed a between-group analysis, comparing patients who developed PTE with those who did not develop PTE. Methods: We assessed early seizure incidence (n = 90) and longitudinal development of PTE (n = 46) in a prospective convenience sample of patients with moderate-severe TBI. Acutely, patients were monitored with prospective cEEG and a high-resolution Magnetic Resonance Imaging (MRI) scan for lesion location classification. Chronically, patients underwent a high-resolution MRI, clinical assessment, and were longitudinally monitored for development of epilepsy for a minimum of 2 years post-injury. Results: Early seizures, occurring within the first week post-injury, occurred in 26.7% of the patients (n = 90). Within the cohort of subjects who had evidence of early seizures (n = 24), 75% had a hemorrhagic temporal lobe injury on admission. For longitudinal analyses (n = 46), 45.7% of patients developed PTE within a minimum of 2 years post-injury. Within the cohort of subjects who developed PTE (n = 21), 85.7% had a hemorrhagic temporal lobe injury on admission and 38.1% had early (convulsive or non-convulsive) seizures on cEEG monitoring during their acute ICU stay. In a between-group analysis, patients with PTE (n = 21) were more likely than patients who did not develop PTE (n = 25) to have a hemorrhagic temporal lobe injury (p < 0.001), worse functional recovery (p = 0.003), and greater temporal lobe atrophy (p = 0.029). Conclusion: Our results indicate that in a cohort of patients with a moderate-severe TBI, 1) lesion location specificity (e.g. the temporal lobe) is related to both a high incidence of early seizures and longitudinal development of PTE, 2) early seizures, whether convulsive or non-convulsive in nature, are associated with an increased risk for PTE development, and 3) patients who develop PTE have greater chronic temporal lobe atrophy and worse functional outcomes, compared to those who do not develop PTE, despite matched injury severity characteristics. This study provides the foundation for a future prospective study focused on elucidating the mechanisms and risk factors for epileptogenesis.

Original languageEnglish (US)
JournalNeurobiology of Disease
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Post-Traumatic Epilepsy
Temporal Lobe
Longitudinal Studies
Seizures
Wounds and Injuries
Atrophy
Incidence
Magnetic Resonance Imaging

Keywords

  • Brain atrophy
  • Brain trauma
  • Coma
  • Post-traumatic epilepsy
  • Seizures
  • Status epilepticus

ASJC Scopus subject areas

  • Neurology

Cite this

Early seizures and temporal lobe trauma predict post-traumatic epilepsy : A longitudinal study. / EpiBioS4Rx Study Group Investigators.

In: Neurobiology of Disease, 01.01.2018.

Research output: Contribution to journalArticle

@article{7a3e564b2bf844d080e823f1e23a741d,
title = "Early seizures and temporal lobe trauma predict post-traumatic epilepsy: A longitudinal study",
abstract = "Objective: Injury severity after traumatic brain injury (TBI) is a well-established risk factor for the development of post-traumatic epilepsy (PTE). However, whether lesion location influences the susceptibility of seizures and development of PTE longitudinally has yet to be defined. We hypothesized that lesion location, specifically in the temporal lobe, would be associated with an increased incidence of both early seizures and PTE. As secondary analysis measures, we assessed the degree of brain atrophy and functional recovery, and performed a between-group analysis, comparing patients who developed PTE with those who did not develop PTE. Methods: We assessed early seizure incidence (n = 90) and longitudinal development of PTE (n = 46) in a prospective convenience sample of patients with moderate-severe TBI. Acutely, patients were monitored with prospective cEEG and a high-resolution Magnetic Resonance Imaging (MRI) scan for lesion location classification. Chronically, patients underwent a high-resolution MRI, clinical assessment, and were longitudinally monitored for development of epilepsy for a minimum of 2 years post-injury. Results: Early seizures, occurring within the first week post-injury, occurred in 26.7{\%} of the patients (n = 90). Within the cohort of subjects who had evidence of early seizures (n = 24), 75{\%} had a hemorrhagic temporal lobe injury on admission. For longitudinal analyses (n = 46), 45.7{\%} of patients developed PTE within a minimum of 2 years post-injury. Within the cohort of subjects who developed PTE (n = 21), 85.7{\%} had a hemorrhagic temporal lobe injury on admission and 38.1{\%} had early (convulsive or non-convulsive) seizures on cEEG monitoring during their acute ICU stay. In a between-group analysis, patients with PTE (n = 21) were more likely than patients who did not develop PTE (n = 25) to have a hemorrhagic temporal lobe injury (p < 0.001), worse functional recovery (p = 0.003), and greater temporal lobe atrophy (p = 0.029). Conclusion: Our results indicate that in a cohort of patients with a moderate-severe TBI, 1) lesion location specificity (e.g. the temporal lobe) is related to both a high incidence of early seizures and longitudinal development of PTE, 2) early seizures, whether convulsive or non-convulsive in nature, are associated with an increased risk for PTE development, and 3) patients who develop PTE have greater chronic temporal lobe atrophy and worse functional outcomes, compared to those who do not develop PTE, despite matched injury severity characteristics. This study provides the foundation for a future prospective study focused on elucidating the mechanisms and risk factors for epileptogenesis.",
keywords = "Brain atrophy, Brain trauma, Coma, Post-traumatic epilepsy, Seizures, Status epilepticus",
author = "{EpiBioS4Rx Study Group Investigators} and Tubi, {Meral A.} and Evan Lutkenhoff and Blanco, {Manuel Buitrago} and David McArthur and Pablo Villablanca and Benjamin Ellingson and Ramon Diaz-Arrastia and {Van Ness}, Paul and Courtney Real and Vikesh Shrestha and Jerome Engel and Vespa, {Paul M.} and Denes Agoston and Alicia Au and Bell, {Michael J.} and Tom Bleck and Craig Branch and {Buitrago Blanco}, Manuel and Ross Bullock and Burrows, {Brian T.} and Jan Claassen and Robert Clarke and James Cloyd and Lisa Coles and Karen Crawford and Ramon Diaz-Arrastia and Dominique Duncan and Benjamin Ellingson and Jerome Engel and Brandon Foreman and Aristea Galanopoulou and Emily Gilmore and Grohn Olli and Neil Harris and Jed Hartings and Hirsch Lawrence and Martin Hunn and Kanner, {Andres M} and Leigh Johnston and Nigel Jones and Andres Kanner and David McArthur and Martin Monti and O'Phelan, {Kristine H} and Solomon Moshe and Wenzhu Mowrey and Terence O'Brien and Kristine O'Phelan and Asla Pitkanen and Rema Raman",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.nbd.2018.05.014",
language = "English (US)",
journal = "Neurobiology of Disease",
issn = "0969-9961",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Early seizures and temporal lobe trauma predict post-traumatic epilepsy

T2 - A longitudinal study

AU - EpiBioS4Rx Study Group Investigators

AU - Tubi, Meral A.

AU - Lutkenhoff, Evan

AU - Blanco, Manuel Buitrago

AU - McArthur, David

AU - Villablanca, Pablo

AU - Ellingson, Benjamin

AU - Diaz-Arrastia, Ramon

AU - Van Ness, Paul

AU - Real, Courtney

AU - Shrestha, Vikesh

AU - Engel, Jerome

AU - Vespa, Paul M.

AU - Agoston, Denes

AU - Au, Alicia

AU - Bell, Michael J.

AU - Bleck, Tom

AU - Branch, Craig

AU - Buitrago Blanco, Manuel

AU - Bullock, Ross

AU - Burrows, Brian T.

AU - Claassen, Jan

AU - Clarke, Robert

AU - Cloyd, James

AU - Coles, Lisa

AU - Crawford, Karen

AU - Diaz-Arrastia, Ramon

AU - Duncan, Dominique

AU - Ellingson, Benjamin

AU - Engel, Jerome

AU - Foreman, Brandon

AU - Galanopoulou, Aristea

AU - Gilmore, Emily

AU - Olli, Grohn

AU - Harris, Neil

AU - Hartings, Jed

AU - Lawrence, Hirsch

AU - Hunn, Martin

AU - Kanner, Andres M

AU - Johnston, Leigh

AU - Jones, Nigel

AU - Kanner, Andres

AU - McArthur, David

AU - Monti, Martin

AU - O'Phelan, Kristine H

AU - Moshe, Solomon

AU - Mowrey, Wenzhu

AU - O'Brien, Terence

AU - O'Phelan, Kristine

AU - Pitkanen, Asla

AU - Raman, Rema

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: Injury severity after traumatic brain injury (TBI) is a well-established risk factor for the development of post-traumatic epilepsy (PTE). However, whether lesion location influences the susceptibility of seizures and development of PTE longitudinally has yet to be defined. We hypothesized that lesion location, specifically in the temporal lobe, would be associated with an increased incidence of both early seizures and PTE. As secondary analysis measures, we assessed the degree of brain atrophy and functional recovery, and performed a between-group analysis, comparing patients who developed PTE with those who did not develop PTE. Methods: We assessed early seizure incidence (n = 90) and longitudinal development of PTE (n = 46) in a prospective convenience sample of patients with moderate-severe TBI. Acutely, patients were monitored with prospective cEEG and a high-resolution Magnetic Resonance Imaging (MRI) scan for lesion location classification. Chronically, patients underwent a high-resolution MRI, clinical assessment, and were longitudinally monitored for development of epilepsy for a minimum of 2 years post-injury. Results: Early seizures, occurring within the first week post-injury, occurred in 26.7% of the patients (n = 90). Within the cohort of subjects who had evidence of early seizures (n = 24), 75% had a hemorrhagic temporal lobe injury on admission. For longitudinal analyses (n = 46), 45.7% of patients developed PTE within a minimum of 2 years post-injury. Within the cohort of subjects who developed PTE (n = 21), 85.7% had a hemorrhagic temporal lobe injury on admission and 38.1% had early (convulsive or non-convulsive) seizures on cEEG monitoring during their acute ICU stay. In a between-group analysis, patients with PTE (n = 21) were more likely than patients who did not develop PTE (n = 25) to have a hemorrhagic temporal lobe injury (p < 0.001), worse functional recovery (p = 0.003), and greater temporal lobe atrophy (p = 0.029). Conclusion: Our results indicate that in a cohort of patients with a moderate-severe TBI, 1) lesion location specificity (e.g. the temporal lobe) is related to both a high incidence of early seizures and longitudinal development of PTE, 2) early seizures, whether convulsive or non-convulsive in nature, are associated with an increased risk for PTE development, and 3) patients who develop PTE have greater chronic temporal lobe atrophy and worse functional outcomes, compared to those who do not develop PTE, despite matched injury severity characteristics. This study provides the foundation for a future prospective study focused on elucidating the mechanisms and risk factors for epileptogenesis.

AB - Objective: Injury severity after traumatic brain injury (TBI) is a well-established risk factor for the development of post-traumatic epilepsy (PTE). However, whether lesion location influences the susceptibility of seizures and development of PTE longitudinally has yet to be defined. We hypothesized that lesion location, specifically in the temporal lobe, would be associated with an increased incidence of both early seizures and PTE. As secondary analysis measures, we assessed the degree of brain atrophy and functional recovery, and performed a between-group analysis, comparing patients who developed PTE with those who did not develop PTE. Methods: We assessed early seizure incidence (n = 90) and longitudinal development of PTE (n = 46) in a prospective convenience sample of patients with moderate-severe TBI. Acutely, patients were monitored with prospective cEEG and a high-resolution Magnetic Resonance Imaging (MRI) scan for lesion location classification. Chronically, patients underwent a high-resolution MRI, clinical assessment, and were longitudinally monitored for development of epilepsy for a minimum of 2 years post-injury. Results: Early seizures, occurring within the first week post-injury, occurred in 26.7% of the patients (n = 90). Within the cohort of subjects who had evidence of early seizures (n = 24), 75% had a hemorrhagic temporal lobe injury on admission. For longitudinal analyses (n = 46), 45.7% of patients developed PTE within a minimum of 2 years post-injury. Within the cohort of subjects who developed PTE (n = 21), 85.7% had a hemorrhagic temporal lobe injury on admission and 38.1% had early (convulsive or non-convulsive) seizures on cEEG monitoring during their acute ICU stay. In a between-group analysis, patients with PTE (n = 21) were more likely than patients who did not develop PTE (n = 25) to have a hemorrhagic temporal lobe injury (p < 0.001), worse functional recovery (p = 0.003), and greater temporal lobe atrophy (p = 0.029). Conclusion: Our results indicate that in a cohort of patients with a moderate-severe TBI, 1) lesion location specificity (e.g. the temporal lobe) is related to both a high incidence of early seizures and longitudinal development of PTE, 2) early seizures, whether convulsive or non-convulsive in nature, are associated with an increased risk for PTE development, and 3) patients who develop PTE have greater chronic temporal lobe atrophy and worse functional outcomes, compared to those who do not develop PTE, despite matched injury severity characteristics. This study provides the foundation for a future prospective study focused on elucidating the mechanisms and risk factors for epileptogenesis.

KW - Brain atrophy

KW - Brain trauma

KW - Coma

KW - Post-traumatic epilepsy

KW - Seizures

KW - Status epilepticus

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DO - 10.1016/j.nbd.2018.05.014

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JO - Neurobiology of Disease

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SN - 0969-9961

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