创伤性脑损伤患者创伤后癫痫与长期功能结局的关系。
Association of Posttraumatic Epilepsy With Long-term Functional Outcomes in Individuals With Severe Traumatic Brain Injury.
机构信息
From the Departments of Neurosurgery (M.P., A.N., D.O.O., J.G-M.), Neurology (J.E., L.S., N.B., J.F.C.), Critical Care (J.E., L.S.), and Emergency Medicine (J.E.), University of Pittsburgh Medical Center, PA.
出版信息
Neurology. 2023 May 9;100(19):e1967-e1975. doi: 10.1212/WNL.0000000000207183. Epub 2023 Mar 22.
BACKGROUND AND OBJECTIVE
Nearly one-third of patients with severe traumatic brain injury (TBI) develop posttraumatic epilepsy (PTE). The relationship between PTE and long-term outcomes is unknown. We tested whether, after controlling for injury severity and age, PTE is associated with worse functional outcomes after severe TBI.
METHODS
We performed a retrospective analysis of a prospective database of patients with severe TBI treated from 2002 through 2018 at a single level 1 trauma center. Glasgow Outcome Scale (GOS) was collected at 3, 6, 12, and 24 months postinjury. We used repeated-measures logistic regression predicting GOS, dichotomized as favorable (GOS 4-5) and unfavorable (GOS 1-3), and a separate logistic model predicting mortality at 2 years. We used predictors as defined by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) base model (i.e., age, pupil reactivity, and GCS motor score), PTE status, and time.
RESULTS
Of 392 patients who survived to discharge, 98 (25%) developed PTE. The proportion of patients with favorable outcomes at 3 months did not differ between those with and without PTE (23% [95% Confidence Interval [CI]: 15%-34%] vs 32% [95% CI: 27%-39%]; = 0.11) but was significantly lower at 6 (33% [95% CI: 23%-44%] vs 46%; [95% CI: 39%-52%] = 0.03), 12 (41% [95% CI: 30%-52%] vs 54% [95% CI: 47%-61%]; = 0.03), and 24 months (40% [95% CI: 47%-61%] vs 55% [95% CI: 47%-63%]; = 0.04). This was driven by higher rates of GOS 2 (vegetative) and 3 (severe disability) outcomes in the PTE group. By 2 years, the incidence of GOS 2 or 3 was double in the PTE group (46% [95% CI: 34%-59%]) compared with that in the non-PTE group (21% [95% CI: 16%-28%]; < 0.001), while mortality was similar (14% [95% CI: 7%-25%] vs 23% [95% CI: 17%-30%]; = 0.28). In multivariate analysis, patients with PTE had lower odds of favorable outcome (odds radio [OR] 0.1; 95% CI: 0.1-0.4; < 0.001), but not mortality (OR 0.9; 95% CI: 0.1-1.9; = 0.46).
DISCUSSION
Posttraumatic epilepsy is associated with impaired recovery from severe TBI and poor functional outcomes. Early screening and treatment of PTE may improve patient outcomes.
背景与目的
近三分之一的严重创伤性脑损伤（TBI）患者会发生创伤后癫痫（PTE）。PTE 与长期预后的关系尚不清楚。我们检验了在控制损伤严重程度和年龄后，PTE 是否与严重 TBI 后的功能预后更差相关。
方法
我们对 2002 年至 2018 年期间在一家单一的 1 级创伤中心接受治疗的严重 TBI 患者前瞻性数据库进行了回顾性分析。格拉斯哥预后量表（GOS）在损伤后 3、6、12 和 24 个月收集。我们使用重复测量逻辑回归预测 GOS，分为有利（GOS 4-5）和不利（GOS 1-3），并使用单独的逻辑模型预测 2 年的死亡率。我们使用国际创伤预后和分析临床试验使命（IMPACT）基本模型（即年龄、瞳孔反应和 GCS 运动评分）、PTE 状态和时间定义的预测因子。
结果
在 392 名存活至出院的患者中，98 名（25%）发生了 PTE。有和无 PTE 的患者在 3 个月时的有利结局比例无差异（23%[95%置信区间（CI）：15%-34%]与 32%[95% CI：27%-39%]； = 0.11），但在 6 个月（33%[95% CI：23%-44%]与 46%[95% CI：39%-52%]； = 0.03）、12 个月（41%[95% CI：30%-52%]与 54%[95% CI：47%-61%]； = 0.03）和 24 个月（40%[95% CI：47%-61%]与 55%[95% CI：47%-63%]； = 0.04）时明显更低。这是由于 PTE 组的 GOS 2（植物状态）和 3（严重残疾）结局发生率更高所致。到 2 年时，PTE 组的 GOS 2 或 3 发生率是无 PTE 组的两倍（46%[95% CI：34%-59%]），而无 PTE 组的发生率为 21%[95% CI：16%-28%]； < 0.001），而死亡率相似（14%[95% CI：7%-25%]与 23%[95% CI：17%-30%]； = 0.28）。在多变量分析中，患有 PTE 的患者的有利结局可能性较低（比值比[OR]0.1；95%CI：0.1-0.4； < 0.001），但死亡率无差异（OR 0.9；95%CI：0.1-1.9； = 0.46）。
讨论
创伤后癫痫与严重 TBI 的恢复不良和功能预后不良有关。早期筛查和治疗 PTE 可能改善患者预后。
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