Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury

Abstract Post-traumatic seizures (PTS) are a common and debilitating complication of traumatic brain injury (TBI) and could have a harmful impact on the progress of patient rehabilitation. To assess the effect of PTS and relative therapy on outcome in the initial phase after TBI, during the rehabili...

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Autores principales:	Valeria Pingue, Chiara Mele, Antonio Nardone
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4c03a8c1fb64447d83da4235adb39940
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spelling	oai:doaj.org-article:4c03a8c1fb64447d83da4235adb399402021-12-02T11:37:18ZPost-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury10.1038/s41598-021-84203-y2045-2322https://doaj.org/article/4c03a8c1fb64447d83da4235adb399402021-02-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-84203-yhttps://doaj.org/toc/2045-2322Abstract Post-traumatic seizures (PTS) are a common and debilitating complication of traumatic brain injury (TBI) and could have a harmful impact on the progress of patient rehabilitation. To assess the effect of PTS and relative therapy on outcome in the initial phase after TBI, during the rehabilitation process when neuroplasticity is at its highest, we retrospectively examined the clinical data of 341 adult patients undergoing rehabilitation for at least 6 months post-TBI in our neurorehabilitation unit between 2008 and 2019. We correlated through logistic regression the occurrence of seizures and use of anti-seizure medication (ASM) with neurological and functional outcomes, respectively assessed with the Glasgow Coma Scale (GCS) and the Functional Independence Measure (FIM). PTS were documented in 19.4% of patients: early PTS (EPTS) in 7.0%; late PTS (LPTS) in 9.4%; both types in 3.0%. Patients who developed EPTS had an increased risk of developing LPTS (OR = 3.90, CI 95% 1.58–9.63, p = 0.003). Patients with LPTS had a significantly higher risk of worse neurological (p < 0.0001) and rehabilitation (p < 0.05) outcome. Overall, 38.7% of patients underwent therapy with ASM; prophylactic therapy was prescribed in 24.0% of patients, of whom 14.6% subsequently developed seizures. Mortality was associated with a lower FIM and GCS score on admission but not significantly with PTS. The use of ASM was associated with a worse rehabilitation outcome, independently of the onset of epilepsy during treatment. LPTS appear to exert a negative impact on rehabilitation outcome and their occurrence is not reduced by prophylactic therapy, whereas EPTS do not influence outcome. Our findings caution against the generic use of prophylactic therapy to prevent post-traumatic epilepsy in patients with TBI.Valeria PingueChiara MeleAntonio NardoneNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Valeria Pingue Chiara Mele Antonio Nardone Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury
description	Abstract Post-traumatic seizures (PTS) are a common and debilitating complication of traumatic brain injury (TBI) and could have a harmful impact on the progress of patient rehabilitation. To assess the effect of PTS and relative therapy on outcome in the initial phase after TBI, during the rehabilitation process when neuroplasticity is at its highest, we retrospectively examined the clinical data of 341 adult patients undergoing rehabilitation for at least 6 months post-TBI in our neurorehabilitation unit between 2008 and 2019. We correlated through logistic regression the occurrence of seizures and use of anti-seizure medication (ASM) with neurological and functional outcomes, respectively assessed with the Glasgow Coma Scale (GCS) and the Functional Independence Measure (FIM). PTS were documented in 19.4% of patients: early PTS (EPTS) in 7.0%; late PTS (LPTS) in 9.4%; both types in 3.0%. Patients who developed EPTS had an increased risk of developing LPTS (OR = 3.90, CI 95% 1.58–9.63, p = 0.003). Patients with LPTS had a significantly higher risk of worse neurological (p < 0.0001) and rehabilitation (p < 0.05) outcome. Overall, 38.7% of patients underwent therapy with ASM; prophylactic therapy was prescribed in 24.0% of patients, of whom 14.6% subsequently developed seizures. Mortality was associated with a lower FIM and GCS score on admission but not significantly with PTS. The use of ASM was associated with a worse rehabilitation outcome, independently of the onset of epilepsy during treatment. LPTS appear to exert a negative impact on rehabilitation outcome and their occurrence is not reduced by prophylactic therapy, whereas EPTS do not influence outcome. Our findings caution against the generic use of prophylactic therapy to prevent post-traumatic epilepsy in patients with TBI.
format	article
author	Valeria Pingue Chiara Mele Antonio Nardone
author_facet	Valeria Pingue Chiara Mele Antonio Nardone
author_sort	Valeria Pingue
title	Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury
title_short	Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury
title_full	Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury
title_fullStr	Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury
title_full_unstemmed	Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury
title_sort	post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/4c03a8c1fb64447d83da4235adb39940
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Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury

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