Predictors and dynamics of posttraumatic epilepsy.

OBJECTIVES

The goal of our study was to identify clinical, neurophysiological and neuroradiological variables in severe head trauma (SHT) with predictive value for posttraumatic epilepsy (PTE) and to evaluate the influence of each risk factor for the dynamics of epilepsy.

MATERIALS AND METHODS

We systematically compared 57 PTE patients with 50 age and sex-matched control patients with SHT and no PTE. Mean follow-up was 8 years.

RESULTS

Of all PTE-patients 68.5% had their first seizure within 2 years after the trauma. Significant risk factors for PTE were focal signs in the first examination (P < 0.01), missile injuries (P < 0.01), frontal lesions (P < 0.01), intracerebral hemorrhage (P < 0.01), diffuse contusion (P < 0.01), prolonged posttraumatic amnesia (P < 0.001), depression fracture (P < 0.01) and cortical-subcortical lesions (P < 0.001). The combination of the last 3 variables conferred a particularly high risk for PTE (logistic regression analysis). Combined seizure pattern, high seizure frequency, AED-noncompliance and alcohol abuse predicted poor seizure control.

CONCLUSION

The risk for PTE is clearly determined by those variables which correlate with the severity, the extent of tissue loss and the penetrating nature of the brain trauma.