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Post-TBI seizures and epilepsy

Eugen Trinka

Universitätsklinik für Neurologie, Salzburg, Austria

At least 2 to 15% of patients with moderate to severe traumatic brain injury (TBI), will suffer from acute symptomatic seizures. Most studies report figures between 2 and 5%. Half of these acute symptomatic seizures occur in the first 24 hours and rates of Status Epilepticus vary between 0.2 and 5%. Acute symptomatic seizures in TBI are associated with an increased mortality, with an increased risk for the development of posttraumatic epilepsy, and with a poor functional outcome.

There is more than 50 years of clinical research in preventing acute symptomatic seizures and its sequelae, especially posttraumatic epilepsy. With our currently available antiseizure medicines, we can significantly lower the risk of early posttraumatic seizures occurring in the first seven days after injury, but these treatments have no significant effect on the risk of late posttraumatic seizures.

Unfortunately, antiseizure medicines are not without any harm, especially on neurocognitive and rehabilitation outcome, independent of the onset of epilepsy. There is significant clinical variability in the current practices of pharmacological management of acute posttraumatic seizures in adults across the globe.

Despite major advances in epidemiology and pathophysiology, some questions still remain unanswered: What is the significance of small posttraumatic MRI-abnormalities? What is the significance of ictal EEG-abnormalities and non-convulsive seizures and Status Epilepticus? Are mild TBI’s at all associated with epilepsy? What is the influence of antiseizure medicines on recovery and long-term outcome? Only sound clinical trials can answer these questions and there is enough evidence to design such.