Close monitoring needed in year after traumatic brain injury

By Eleanor McDermid, Senior medwireNews Reporter

Patients are at particularly high risk for developing epilepsy during the first year after traumatic brain injury (TBI), a study shows.

The research team also pinned down several predictors for epilepsy, most notably having skull fracture and having intracranial bleeding - particularly if patients had more than one type of hemorrhage simultaneously.

"These findings could provide clinicians with a spectrum to understand potential risk factors relating to post-trauma epilepsy," write Chien-Chang Liao (Taipei Medical University Hospital, Taiwan) and co-workers in the Journal of Neurology, Neurosurgery, and Psychiatry.

"The combined care policy can be developed by neurosurgeons, neurologists and associated medical team members for these specific patient populations."

The team's study data were drawn from an insurance claims database, which included 19,336 patients with TBI and 540,322 without (controls). The rates of epilepsy after the time of injury in the TBI patients were 1.9% and 0.3%, respectively, which was a significant difference.

Epilepsy risk was elevated in all TBI patients, but was highest among those with the most severe injuries, ie, skull fracture, at an 11-fold increase relative to controls after accounting for age, gender, low income, urbanization, and comorbidities. The risk was elevated fivefold and threefold in patients with severe and mild brain injury, respectively (both significant increases).

"As skull fractures cause high-impact damage to the skull and deeper trauma to brain matter, especially in patients with skull base fracture, it is understandable that patients with skull fractures had the highest epilepsy risk," say Liao et al.

The risk was also affected by time since injury. During the first year after injury, the incidence of epilepsy among patients with skull fracture was 25 per 1000 person-years, compared with 0.4 per 1000 person-years among controls, giving an adjusted 38-fold risk increase. The risk versus controls was less elevated thereafter, at 12-fold during the second year, sixfold during the third and fourth years, and a nonsignificant twofold from the fourth year onward.

Intracranial bleeding raised epilepsy risk, with subarachnoid hemorrhage, intracerebral hemorrhage, subdural hemorrhage, and epidural hemorrhage associated with risk increases ranging from three- to fivefold, relative to brain contusion alone. Patients who had more than one type of bleeding had a further increased risk, approaching eightfold, with an overall incidence of 23 per 1000 person-years, compared with 2.3 per 1000 person-years in patients with brain contusion only.

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