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Early Seizures after Severe Closed Head Injury

Published online by Cambridge University Press:  18 September 2015

Shih-Tseng Lee*
Affiliation:
Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung Medical College, Taoyuan, Taiwan.
Tai-Ngar Lui
Affiliation:
Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung Medical College, Taoyuan, Taiwan.
Cheuk-Wah Wong
Affiliation:
Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung Medical College, Taoyuan, Taiwan.
Yi-Shen Yeh
Affiliation:
Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung Medical College, Taoyuan, Taiwan.
Wen-Ching Tzuan
Affiliation:
Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung Medical College, Taoyuan, Taiwan.
Tzu-Yung Chen
Affiliation:
Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung Medical College, Taoyuan, Taiwan.
Shang-Yu Hung
Affiliation:
Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung Medical College, Taoyuan, Taiwan.
Chieh-Tsai Wu
Affiliation:
Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung Medical College, Taoyuan, Taiwan.
*
Department of Neurosurgery, Chang Gung Memorial Hospital & Chang Gung Medical College, 5, Fu-Shing Street, Taoyuan, 333, Taiwan, Republic of China
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Abstract:

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Background:

We studied the incidence and clinical significance of early post-traumatic seizures after severe closed head injury.

Methods:

This prospective study is based on clinical observation of 3340 adult patients with severe closed head injuries, each of them having a Glasgow Coma Scale (GCS) 3 to 8 after trauma. Anticonvulsant agents were not given to these patients unless there was evidence of seizure.

Results:

One hundred and twenty-one patients (3.6%) experienced seizures within 1 week after head injury; 42 of these (1.26% of the series) had seizures within 24 hours after trauma. The incidence of intracerebral parenchymal damage was found to be higher among those patients who developed seizures in the first week (66.1%) than in those who did not (62.7%). However this result did not reach statistical significance. The patients with early seizures had a lower mortality rate (p < 0.01). In patients who survived from the initial injury, the occurrence of early post-traumatic seizures did not appear to influence the neurological recovery at 6 months after injury.

Conclusion:

Presence of intracerebral parenchymal damage on CT scan after severe closed head injury does not increase the risk of early post-traumatic seizures. With proper treatment, patients presenting with early seizures may have a lower mortality rate. However, the occurrence of early seizures does not influence the neurological recovery in patients who survive the initial severe closed head injury.

Résumé:

RÉSUMÉ:Introduction:

Notre but était d'étudier l'incidence et la signification clinique de l'épilepsie post-traumatique précoce.

Matériel et méthodes:

Cette étude prospective est basée sur l'observation clinique de 3340 patients adultes ayant subi un traumatisme crânien fermé sévère. Après le traumatisme, chacun d'eux avait un score de 3 à 8 à l'échelle de coma de Glasgow. Des agents anticonvulsivants n'ont pas été administrés à ces patients, à moins qu'il n'y ait eu évidence d'épilepsie.

Résultats:

Cent vingt-et-un patients (3.6%) ont présenté de l'épilepsie dans la semaine qui a suivi le traumatisme; chez 42 de ces patients (1.26% du groupe total) l'épilepsie est survenue dans les 24 heures du traumatisme. L'incidence de dommage parenchymateux intracérébral était plus élevée chez les patients qui ont présenté de l'épilepsie dans la première semaine (66.1%) que chez ceux que n'en ont pas présenté. Cependant, ce résultat n'était pas statistiquement significatif. Les patients qui ont présenté de l'épilepsie précocement ont eu un taux de mortalité plus bas (P0.01). Chez les patients qui ont survécu au traumatisme initial, l'apparition d'épilepsie post-traumatique précoce n'a pas semblé influencer la récupération neurologique mesurée 6 mois après le traumatisme.

Conclusions:

Après un traumatisme crânien fermé sévère la présence de dommage parenchymateux intracérébral au CT scan n'augmente pas le risque d'épilepsie post-traumatique précoce. Avec un traitement approprié, les patients presentant de l'épilepsie précoce peuvent avoir un taux de mortalité inférieur. Cependant, l'apparition d'épilepsie tôt après le traumatisme n'influence pas la récupération neurologique chez les patients qui survivent à un traumatisme crânien fermé sévère.

Type
Original Articles
Copyright
Copyright © Canadian Neurological Sciences Federation 1997

References

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