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Is Concussion a Risk Factor for Epilepsy?

  • Richard Wennberg (a1) (a2), Carmen Hiploylee (a1), Peter Tai (a2) and Charles H. Tator (a1) (a3)

Abstract

Background: Epidemiologic studies have suggested that concussion, or mild traumatic brain injury (mTBI), is associated with a twofold or greater increase in relative risk for the development of post-traumatic epilepsy. To assess the clinical validity of these findings, we analyzed the incidence of epilepsy in a large cohort of post-concussion patients in whom concussion was strictly defined according to international guidelines. Methods: A retrospective cohort study of 330 consecutive post-concussion patients followed by a single concussion specialist. Exclusion criteria: abnormal brain CT/MRI, Glasgow Coma Scale<13 more than 1-hour post-injury, hospitalization >48 hours. Independent variable: concussion. Outcome measure: epilepsy incidence (dependent variable). Results: The mean number of concussions/patient was 3.3 (±2.5), mean age at first clinic visit 28 years (±14.7), and mean follow-up after first concussion 7.6 years (±10.8). Eight patients were identified whose medical records included mention of seizures or convulsions or epilepsy. Upon review by an epileptologist none met criteria for a definite diagnosis of epilepsy: four had episodic symptoms incompatible with epileptic seizures (e.g., multifocal paraesthesiae, multimodality hallucinations, classic migraine) and normal EEG/MRI investigations; four had syncopal (n=2) or concussive (n=2) convulsions. Compared with annual incidence (0.5/1000 individuals) in the general population, there was no difference in this post-concussion cohort (p=0.49). Conclusion: In this large cohort of post-concussion patients we found no increased incidence of epilepsy. For at least the first 5-10 years post-injury, concussion/mTBI should not be considered a significant risk factor for epilepsy. In patients with epilepsy and a past history of concussion, the epilepsy should not be presumed to be post-traumatic.

Les commotions cérébrales représentent-elles un facteur de risque pour l’épilepsie? Contexte: Des études épidémiologiques ont suggéré que les commotions cérébrales ou les traumatismes cranio-cérébraux (TCC) légers pouvaient être associés à une augmentation deux fois plus élevée (ou nettement plus grande) d’être atteint d’épilepsie post-traumatique. Afin d’examiner la validité clinique de ce constat, nous avons analysé l’incidence de l’épilepsie au sein d’une vaste cohorte de patients ayant souffert précédemment d’une commotion cérébrale et pour lesquels ce traumatisme a été identifié rigoureusement en vertu de lignes directrices internationales. Méthodes: Il s’est agi d’une étude de cohorte rétrospective rassemblant 330 patients successifs ayant souffert d’une commotion cérébrale. Tous ces patients avaient été suivis par le même spécialiste des commotions cérébrales. Des critères d’exclusion avaient été établis : présence d’anomalies cérébrales détectées par tomographie assistée par ordinateur et par IRM ; <13 obtenu à l’échelle de Glasgow, et ce, plus d’une heure à la suite du traumatisme ; hospitalisation >48 heures. Cette étude comportait une variable indépendante : les commotions cérébrales ; le résultat clinique, lui, cherchait à mesurer l’incidence de l’épilepsie (variable dépendante). Résultats: Le nombre moyen de commotions cérébrales par patient était de 3,3 (± 2,5) ; leur âge moyen au moment de leur première consultation était de 28 ans (± 14,7) ; enfin, la période de suivi moyen après la première commotion cérébrale était de 7,6 ans (± 10,8). Huit patients préalablement identifiés possédaient des dossiers médicaux où il était question de convulsions, d’attaques convulsives ou d’épilepsie. Après qu’un épileptologue a analysés leurs dossiers, aucun patient ne satisfaisait aux critères autorisant un diagnostic précis d’épilepsie. Ainsi, quatre d’entre eux avaient montré des symptômes épisodiques ne correspondant pas à ceux des crises épileptiques (p.ex. : des signes de paresthésie multifocale, des hallucinations multimodales, des signes de migraine avec aura) et des résultats d’électroencéphalographie et d’IRM normaux. On a aussi détecté chez quatre autres patients des convulsions entraînant une perte de connaissance (n=2) ou des convulsions apparues à la suite d’une commotion cérébrale (n=2). Au sein de notre cohorte post-commotion cérébrale (p=0,49), aucune différence n’a émergé par rapport à l’incidence annuelle au sein de la population générale (0,5/1000 individus). Conclusions: Nous n’avons pas observé d’augmentation de l’incidence de l’épilepsie au sein de cette vaste cohorte de patients ayant été victimes antérieurement d’une commotion cérébrale. Pour au moins les 5 à 10 premières années consécutives à une commotion cérébrale ou à un TCC léger, ces derniers ne devraient pas être considérés comme des facteurs de risque importants en ce qui a trait à l’épilepsie. Chez des patients ayant des antécédents d’épilepsie et de commotion cérébrale, on ne devrait pas présumer que l’épilepsie est d’origine post-traumatique.

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Copyright

This is an open access article, distributed under the terms of the creative commons attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence to: Richard Wennberg, Toronto Western Hospital, 399 Bathurst Street, Suite 5W444, Toronto, ON, Canada M5T 2S8. Email: richard.wennberg@uhn.ca

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