COURSE OF EPILEPTIC SEIZURES IN PATIENTS AFTER TRAUMATIC BRAIN INJURY: CLINICAL OBSERVATIONS OF 23 CASES
Article Sidebar
Main Article Content
Abstract
Post-traumatic epilepsy (PTE) is one of the most disabling long-term complications of traumatic brain injury (TBI). Despite progress in acute neurotrauma care, epileptic seizures remain a major cause of morbidity, drug resistance, and impaired quality of life among survivors.
Objective: To analyze the course, clinical features, and outcomes of epileptic seizures in patients with TBI.
Methods: A total of 23 patients with post-traumatic seizures were observed for a mean follow-up of 24 months. Clinical data, electroencephalography (EEG), and neuroimaging findings were assessed. Seizures were classified according to the International League Against Epilepsy (ILAE 2017). Treatment outcomes and the rate of drug-resistant epilepsy (DRE) were evaluated.
Results: Early post-traumatic seizures occurred in 30.4% of patients, while late seizures predominated (69.6%). Generalized tonic–clonic seizures were the most frequent type (51.2%). EEG abnormalities were present in 78.3% of cases, most often localized to the temporal lobes. Cortical contusions and hematomas were the leading imaging correlates. Levetiracetam was the most commonly prescribed antiepileptic drug (60.8%). Seizure control was achieved in 65.2% of patients, whereas 34.8% developed DRE. Psychiatric comorbidities (depression and anxiety) were reported in 26.1%.
Conclusion: Epileptic seizures after TBI are predominantly late in onset and frequently associated with temporal lobe lesions. Approximately one-third of patients develop drug resistance, underscoring the need for early risk stratification, individualized therapy, and preventive strategies to reduce the burden of PTE.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Ahmedov, B. S., & Tursunov, J. J. (2021). Posttravmatik epilepsiya: klinik ko‘rinishlari va davolash usullari. O‘zbekiston tibbiyot jurnali, 2(5), 67–73.
Annegers, J. F., Hauser, W. A., Coan, S. P., & Rocca, W. A. (1998). A population-based study of seizures after traumatic brain injuries. New England Journal of Medicine, 338(1), 20–24. https://doi.org/10.1056/NEJM199801013380104
Beghi, E. (2020). The epidemiology of epilepsy. Neuroepidemiology, 54(2), 185–191. https://doi.org/10.1159/000503831
Belousov, Yu. B., & Shandra, A. A. (2015). Posttravmaticheskaya epilepsiya: sovremennye predstavleniya o patogeneze i lechenii. Zhurnal nevrologii i psikhiatrii im. S. S. Korsakova, 115(6), 74–81.
Burd, G. S., & Ryabtseva, N. V. (2018). Epilepticheskie pripadki posle cherepno-mozgovoy travmy: kliniko-epidemiologicheskie aspekty. Vestnik Rossiyskoy akademii meditsinskikh nauk, 73(9), 815–823.
Christensen, J. (2009). The epidemiology of posttraumatic epilepsy. Seminars in Neurology, 29(3), 218–222. https://doi.org/10.1055/s-0029-1223874
DeGiorgio, C. M., Taha, A. Y., & Baca, C. B. (2019). Epilepsy and traumatic brain injury: From pathophysiology to prevention. Epilepsy & Behavior, 100, 106387. https://doi.org/10.1016/j.yebeh.2019.106387
Devinsky, O. (2016). Sudden unexpected death in epilepsy. New England Journal of Medicine, 375(14), 1394–1395. https://doi.org/10.1056/NEJMcibr1608304
Drobinskiy, A. I., & Kasatkina, L. V. (2017). Pozdnie epilepticheskie pripadki pri cherepno-mozgovoy travme: faktory riska i iskhody. Nevrologicheskiy zhurnal, 22(3), 45–51.
Engel, J., Pitkänen, A., Loeb, J. A., Dudek, F. E., Bertram, E. H., Cole, A. J., … & Scharfman, H. (2013). Epilepsy biomarkers. Epilepsia, 54(Suppl. 4), 61–69. https://doi.org/10.1111/epi.12299
Englander, J., Bushnik, T., Duong, T. T., Cifu, D. X., Zafonte, R., Wright, J., … & Katz, D. I. (2003). Analyzing risk factors for late posttraumatic seizures: A prospective, multicenter investigation. Archives of Physical Medicine and Rehabilitation, 84(3), 365–373. https://doi.org/10.1053/apmr.2003.50022
Fisher, R. S., Acevedo, C., Arzimanoglou, A., Bogacz, A., Cross, J. H., Elger, C. E., … & Wiebe, S. (2014). ILAE official report: A practical clinical definition of epilepsy. Epilepsia, 55(4), 475–482. https://doi.org/10.1111/epi.12550
Fisher, R. S., Cross, J. H., French, J. A., Higurashi, N., Hirsch, E., Jansen, F. E., … & Zuberi, S. M. (2017). Operational classification of seizure types by the International League Against Epilepsy. Epilepsia, 58(4), 522–530. https://doi.org/10.1111/epi.13670
Frey, L. C. (2003). Epidemiology of posttraumatic epilepsy: A critical review. Epilepsia, 44(Suppl. 10), 11–17. https://doi.org/10.1111/j.0013-9580.2003.12005.x
Gupta, P. K., Sayed, N., Ding, K., Agostini, M. A., Van Ness, P. C., Yablon, S., & Madden, C. J. (2014). Subtypes of post-traumatic epilepsy: Clinical, electrophysiological, and neuroimaging features. Journal of Neurotrauma, 31(16), 1439–1443. https://doi.org/10.1089/neu.2014.3340
Haltiner, A. M., Temkin, N. R., & Dikmen, S. S. (1997). Risk of seizure recurrence after the first late posttraumatic seizure. Archives of Physical Medicine and Rehabilitation, 78(8), 835–840. https://doi.org/10.1016/S0003-9993(97)90095-6
Herman, S. T. (2002). Epilepsy after brain insult: Targeting epileptogenesis. Neurology, 59(9 Suppl. 5), S21–S26. https://doi.org/10.1212/WNL.59.9_suppl_5.S21
Karimov, M. R., & Yusupov, A. K. (2020). Miya jarohatlaridan keyingi epileptik xurujlar: klinik kuzatuvlar. Samarkand davlat tibbiyot instituti axborotnomasi, 101(3), 112–118.
Krylov, V. V., & Gusev, E. I. (2014). Travmaticheskaya bolezn mozga i epilepsiya. Zhurnal nevrologii i psikhiatrii im. S. S. Korsakova, 114(5), 10–17.
Kwan, P., Arzimanoglou, A., Berg, A. T., Brodie, M. J., Allen Hauser, W., Mathern, G., … & French, J. (2010). Definition of drug-resistant epilepsy. Epilepsia, 51(6), 1069–1077. https://doi.org/10.1111/j.1528-1167.2009.02397.x
Kwan, P., Sander, J. W., & Brodie, M. J. (2011). The molecular basis of pharmacoresistant epilepsy. Epilepsia, 52(Suppl. 9), 29–38. https://doi.org/10.1111/j.1528-1167.2011.03229.x
Lowenstein, D. H. (2009). Epilepsy after head injury: An overview. Epilepsia, 50(Suppl. 2), 4–9. https://doi.org/10.1111/j.1528-1167.2008.02004.x
Machinskiy, A. A., & Chistyakov, A. V. (2019). Posttravmaticheskaya epilepsiya: diagnostika, prognoz, profilaktika. Rossiyskiy meditsinskiy zhurnal, 25(4), 24–30.
Maas, A. I. R., Menon, D. K., Adelson, P. D., Andelic, N., Bell, M. J., Belli, A., … & Manley, G. T. (2017). Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology, 16(12), 987–1048. https://doi.org/10.1016/S1474-4422(17)30371-X
Pitkänen, A., & Engel, J. Jr. (2014). Past and present definitions of epileptogenesis and its biomarkers. Neurotherapeutics, 11(2), 231–241. https://doi.org/10.1007/s13311-014-0257-2
Pitkänen, A., & Immonen, R. J. (2014). Epilepsy related to traumatic brain injury. Neurotherapeutics, 11(2), 286–296. https://doi.org/10.1007/s13311-014-0250-9
Pitkänen, A., Lukasiuk, K., Dudek, F. E., & Staley, K. J. (2016). Epileptogenesis. Cold Spring Harbor Perspectives in Medicine, 6(6), a022822. https://doi.org/10.1101/cshperspect.a022822
Raximov, I. T., & Qodirov, A. A. (2019). Travmatik bosh miya shikastidan keyingi kech epileptik tutqanoqlar. Tibbiyotda yangi kun, 4(27), 54–59.
Shodmonov, F. B., & To‘xtayev, A. N. (2022). Posttravmatik epilepsiyada diagnostika va davolashning dolzarb masalalari. Buxoro tibbiyot jurnali, 5(2), 90–96.
Suponyeva, N. A., & Troshin, V. V. (2020). Nevrologicheskie posledstviya tyazheloy cherepno-mozgovoy travmy: epilepsiya, kognitivnye narusheniya. Nevrologiya, neyropsikhiatriya, psikhosomatika, 12(1), 40–47.
Temkin, N. R. (2009). Preventing and treating posttraumatic seizures: The human experience. Epilepsia, 50(Suppl. 2), 10–13. https://doi.org/10.1111/j.1528-1167.2008.02005.x
Tursunov, J. J., & O‘rinboyev, S. R. (2021). Epileptik xurujlarning oqibatlari va reabilitatsiya usullari. Andijon tibbiyot jurnali, 3(4), 77–83.
Usmonov, S. N., & Jalilov, R. R. (2021). Miya shikastlanishidan keyingi epilepsiya: davolash natijalari. Toshkent tibbiyot akademiyasi ilmiy xabarlari, 18(4), 99–106.
Walker, L. E., Janigro, D., Heinemann, U., Riikonen, R., Bernard, C., & Patel, M. (2018). WONOEP appraisal: Molecular and cellular biomarkers for epilepsy. Epilepsia, 59(7), 1291–1302. https://doi.org/10.1111/epi.14407
Walker, M. C., & White, H. S. (2017). Animal models for epileptogenesis: The post-traumatic epilepsy model. Epilepsia, 58(Suppl. 3), 19–27. https://doi.org/10.1111/epi.13717
Yo‘ldoshev, H. K., & Mamadjonov, A. I. (2018). Posttravmatik epilepsiyada neyroimagingning ahamiyati. O‘zbekiston neyrologiya jurnali, 1(6), 45–52.
Yuldasheva, M. R., & O‘ktamov, A. B. (2019). Travmadan keyingi epileptogenez mexanizmlari. O‘zbekiston fan va ta’lim jurnali, 12(1), 56–62.
Zhirmunskaya, E. A., & Kuznetsova, A. A. (2016). Posttravmaticheskaya epilepsiya u voennosluzhashchikh: osobennosti techeniya. Meditsinskiy akademicheskiy zhurnal, 16(2), 38–44.
Zokirov, A. B., & Islomov, D. T. (2020). Posttravmatik epilepsiya bo‘yicha klinik kuzatuvlar. Qashqadaryo tibbiyot jurnali, 7(2), 33–39.
Qodirova, N. S., & Alimov, B. T. (2022). Posttravmatik epilepsiya: klinik kechishi va psixologik oqibatlari. Neyrofan va amaliyot, 14(3), 28–35.