Objective: To estimate national frequency of posttraumatic epilepsy (PTE) after severe traumatic brain injury (TBI) and assess injury severity (Glasgow Coma Scale (GCS) and posttraumatic amnesia (PTA)) as prognostic factors for PTE.

Methods

Data on patients ≥18 years surviving severe TBI 2004–2016 were retrieved from the Danish Head Trauma Database (n = 1010). The cumulative incidence proportion (CIP) was estimated using death as competing event. The association between injury severity and PTE was assessed using multivariable competing risk regressions.

Results

CIP of PTE 28 days and one year post-TBI was 6.8% (95% confidence interval (CI) 5.4–8.5) and 18.5% (95% CI 16.1–21.1%), respectively. Injury severity was not associated with PTE within 28 days post-TBI but indicated higher PTE-rates in less severely injured patients. PTA-duration >70 days was associated with PTE 29–365 days post-TBI (Adjusted sub-hazard ratio 4.23 (95% CI 1.79–9.99)). GCS was not associated with PTE 29–365 days post-TBI.

Conclusion

The PTE frequency was higher compared to previous estimates. Increasing injury severity was associated with PTE 29–365 days post-TBI when measured with PTA, but not with GCS. Though nonsignificant, the increased PTE-risk within 28 days in lower severity suggests an underdiagnosing of PTE.

中文翻译：

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严重的颅脑外伤后癫痫发作：频率和损伤严重程度。

目的：评估严重创伤性脑损伤（TBI）后创伤后癫痫（PTE）的全国发生频率，并评估损伤严重程度（格拉斯哥昏迷量表（GCS）和创伤后遗忘症（PTA））作为PTE的预后因素。

方法

从丹麦头部创伤数据库（n = 1010）中检索了2004-2016年严重TBI幸存的≥18岁患者的数据。使用死亡作为竞争事件来估计累积发生率（CIP）。损伤严重程度与PTE之间的关联使用多变量竞争风险回归进行评估。

结果

TBI后28天和一年的PTE的CIP分别为6.8％（95％置信区间（CI）5.4-8.5）和18.5％（95％CI 16.1-21.1％）。在TBI后28天内，损伤严重程度与PTE无关，但表明受伤较轻的患者PTE发生率较高。TTA持续时间> 70天与TBI后29-365天PTE相关（调整后的亚危险比4.23（95％CI 1.79-9.99））。TBI后29–365天，GCS与PTE无关。

结论

与以前的估计相比，PTE频率更高。当用PTA而非GCS进行测量时，损伤严重程度的增加与TBI后29-365天的PTE有关。尽管不显着，但严重程度较低的28天内PTE风险增加表明PTE的诊断不足。