Rabiu Taopheeq Bamidele, Adetunmbi Babatunde
Division of Neurological Surgery, Department of Surgery, Federal Teaching Hospital, Ido-Ekiti, Nigeria; Division of Neurological Surgery, Department of Surgery, Lautech Teaching Hospital, Osogbo, Nigeria.
Division of Neurological Surgery, Department of Surgery, Federal Teaching Hospital, Ido-Ekiti, Nigeria.
World Neurosurg. 2017 Aug;104:367-371. doi: 10.1016/j.wneu.2017.04.133. Epub 2017 Apr 29.
Traumatic brain injury (TBI) is a recognized risk factor for seizures. In Nigeria, there is paucity of literature on posttraumatic seizure (PTS). This study provides the profile and pattern of PTS in patients with TBI in a rural Nigerian neurosurgical service.
A prospective observational study of patients with TBI was performed. Clinical and radiological data including outcomes of care were analyzed with SPSS version 15. A P value of <0.05 was considered statistically significant.
A total of 199 patients were managed for TBI. There were 20 (10.1%) cases of PTS. Mean age was 28.4 years (range: 5-80 years) and most were male (n = 16; 80%). The average admission Glasgow Coma Scale score was 10 (range: 3-15). Of the 20 patients with PTS, 10 (50%) had mild head injury whereas 3 (15%) and 7 (35%) had moderate and severe head injuries, respectively. PTS peaked in young patients aged 17-45 years (n = 14, 70%). Fourteen (n = 14, 70%) had immediate PTS, whereas 6 (30%) had early PTS. Increasing severity of head injury resulted in a greater incidence of PTS (7.8%, 10.3%, and 17.1% for mild, moderate, and severe head injuries, respectively). Findings of acute subdural hematoma and contusions on computed tomography scan are significant risk factors for PTS (χ: 22.8; P value: 0.0004). Five (25%) patients required anticonvulsant therapy because of seizure recurrence, but only one progressed to late PTS. Four (20.0%) died, whereas the rest had good outcome.
Severe TBI and computed tomography findings of acute subdural hematoma and cerebral contusions are predictors of PTS in our environment. Progression of immediate/early to late PTS is rare.
创伤性脑损伤（TBI）是公认的癫痫发作危险因素。在尼日利亚，关于创伤后癫痫（PTS）的文献匮乏。本研究呈现了尼日利亚农村神经外科服务中TBI患者的PTS概况和模式。
对TBI患者进行前瞻性观察研究。使用SPSS 15版对包括护理结果在内的临床和放射学数据进行分析。P值<0.05被认为具有统计学意义。
共对199例TBI患者进行了治疗。有20例（10.1%）发生PTS。平均年龄为28.4岁（范围：5 - 80岁），大多数为男性（n = 16；80%）。入院时格拉斯哥昏迷量表平均评分为10分（范围：3 - 15分）。在20例PTS患者中，10例（50%）为轻度颅脑损伤，3例（15%）为中度颅脑损伤，7例（35%）为重度颅脑损伤。PTS在17 - 45岁的年轻患者中达到峰值（n = 14，70%）。14例（n = 14，70%）发生即刻PTS，而6例（30%）发生早期PTS。颅脑损伤严重程度增加导致PTS发生率更高（轻度、中度和重度颅脑损伤的发生率分别为7.8%、10.3%和17.1%）。计算机断层扫描显示急性硬膜下血肿和脑挫伤是PTS的重要危险因素（χ：22.8；P值：0.0004）。5例（25%）患者因癫痫复发需要抗惊厥治疗，但只有1例进展为晚期PTS。4例（20.0%）死亡，其余患者预后良好。
在我们的环境中，重度TBI以及急性硬膜下血肿和脑挫伤的计算机断层扫描结果是PTS的预测因素。即刻/早期PTS进展为晚期PTS的情况罕见。
