scholarly journals Clinical characteristics of post-traumatic epilepsy and the factors affecting the latency of PTE

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tingting Yu ◽  
Xiao Liu ◽  
Lei Sun ◽  
Jianping Wu ◽  
Qun Wang
Keyword(s):  
Clinical Characteristics ◽  
Seizure Type ◽  
Factors Affecting ◽  
Acute Seizures ◽  
Kaplan Meier ◽  
Severe Tbi ◽  
Post Traumatic ◽  
Drug Resistant Epilepsy ◽  
Post Traumatic Epilepsy ◽  
Surgical Operations

Abstract Objectives To summarize the clinical characteristics of post-traumatic epilepsy (PTE), and to identify the factors affecting the latency of PTE after traumatic brain injury (TBI). Methods We conducted a retrospective clinical analysis in patients with PTE who visited the outpatient Department of Epilepsy, Beijing Tiantan Hospital from January 2013 to December 2018. The clinical characteristics, including gender, age distribution, seizure type, and latency were summarized. Factors affecting the latency of PTE were evaluated using Kaplan-Meier curves and Cox proportional hazard regression analysis. Results Complete clinical information was available for 2862 subjects, of which 78.48% were males. The mean age at TBI was 21.4 ± 15.1 years and peaked in the 0 to 12-year-old and 15 to 27-year-old groups. Generalized onset seizure was the most frequent seizure type (72.82% of patients). Approximately 19.95% PTE patients developed drug-resistant epilepsy. The latency of PTE ranged from 8 days to 20 years, with a median of 24.0 (IQR, 5.0–84.0) months. The Kaplan-Meier curves demonstrated that gender, age at TBI, severity of TBI, multiple craniocerebral injuries, post-TBI treatments, acute seizures, and residual disability were associated with PTE latency. The Cox regression model indicated that age ≥ 18 years old, severe TBI with multiple surgical operations, acute seizures, and residual disability were risk factors for shorter PTE latency. Conclusions PTE is more common in males than females, and peaked in the 0 to 12-year-old and 15 to 27-year-old groups. Generalized onset seizure was the most common seizure type and 19.95% of participants developed drug-resistant epilepsy. Patients aged ≥18 years old, who suffered severe TBI followed by multiple surgical operations, experienced acute seizures, or with residual disabilities had shorter PTE latency.

scholarly journals Lesion Normalization and Supervised Learning in Post-Traumatic Seizure Classification with Diffusion MRI

2021 ◽  
Author(s):  
Md Navid Akbar ◽  
Sebastian Ruf ◽  
Marianna La Rocca ◽  
Rachael Garner ◽  
Giuseppe Barisano ◽  
...  
Keyword(s):  
White Matter ◽  
Area Under The Curve ◽  
The Novel ◽  
Potential Biomarker ◽  
Neuroimaging Data ◽  
Severe Tbi ◽  
Post Traumatic ◽  
Magnetic Resonance Imaging Mri ◽  
Post Traumatic Epilepsy ◽  
Seizure Classification

Traumatic brain injury (TBI) is a serious condition, potentially causing seizures and other lifelong disabilities. Patients who experience at least one seizure one week after TBI (late seizure) are at high risk for lifelong complications of TBI, such as post-traumatic epilepsy (PTE). Identifying which TBI patients are at risk of developing seizures remains a challenge. Although magnetic resonance imaging (MRI) methods that probe structural and functional alterations after TBI are promising for biomarker detection, physical deformations following moderate-severe TBI present problems for standard processing of neuroimaging data, complicating the search for biomarkers. In this work, we consider a prediction task to identify which TBI patients will develop late seizures, using fractional anisotropy (FA) features from white matter tracts in diffusion-weighted MRI (dMRI). To understand how best to account for brain lesions and deformations, four preprocessing strategies are applied to dMRI, including the novel application of a lesion normalization technique to dMRI. The pipeline involving the lesion normalization technique provides the best prediction performance, with a mean accuracy of 0.819 and a mean area under the curve of 0.785. Finally, following statistical analyses of selected features, we recommend the dMRI alterations of a certain white matter tract as a potential biomarker.

scholarly journals Sleep-wake Characteristics in a Mouse Model of Severe Traumatic Brain Injury: Relation to Post-Traumatic Epilepsy

2020 ◽  
Author(s):  
Sai Sruthi Konduru ◽  
Eli P Wallace ◽  
Jesse A Pfammatter ◽  
Paulo V Rodrigues ◽  
Mathew V Jones ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Epileptiform Activity ◽  
Brain Lesions ◽  
Delta Power ◽  
Injury Group ◽  
Severe Tbi ◽  
Post Traumatic ◽  
Post Traumatic Epilepsy ◽  
Traumatic Epilepsy

AbstractStudy objectivesTraumatic brain injury (TBI) results in sequelae that include post-traumatic epilepsy (PTE) and sleep-wake disturbances. Here we sought to determine whether sleep characteristics could predict development of PTE in a model of severe TBI.MethodsFollowing controlled cortical impact (CCI), sham injury (craniotomy only) or no craniotomy (NC), CD-1 mice were implanted with epidural electroencephalography (EEG) and nuchal electromyography (EMG) electrodes. Acute (1st week) and chronic (months 1, 2 and 3 after injury) 1-week long video-EEG/EMG recordings were examined for epileptiform activity. We analyzed sleep-wake patterns manually and extracted high amplitude interictal events from EEG using an automated method. Sleep spindles and EEG delta power were derived from non-rapid eye movement (NREM) sleep epochs. Brain CTs (computerized tomography) were performed to quantify the extent of brain lesions in cohorts of sham and CCI.ResultsPosttraumatic seizures were seen with CCI, whereas interictal epileptiform activity as well as sleep-wake disruptions (shorter wake or NREM bout lengths, shorter duration or lower power for spindles, and increased NREM EEG delta power) were seen in CCI and sham groups. No sleep feature predicted PTE. Follow up brain CTs showed a small lesion in the sham injury group suggesting a milder form of TBI that may account for their interictal activity and sleep changes.ConclusionsIn our model, interictal epileptiform activity and sleep disruptions resulted from CCI and sham and thus, sham injury was not an optimal negative control. Further work is necessary to determine the relationship between sleep-wake disturbances and PTE.Statement of significanceTraumatic brain injury (TBI) results in sequelae such as post-traumatic seizures and sleep-wake disturbances but it is difficult to predict which individuals will develop these symptoms. Our study is novel in that we characterized epileptiform activity and multiple sleep characteristics in a mouse model of severe TBI (Controlled cortical impact-CCI) and explored whether any specific sleep disturbance can predict post-traumatic epilepsy. Specifically, post-traumatic seizures were seen after CCI only whereas epileptiform activity other than seizures as well as sleep-wake disruptions in mice that received a TBI and their sham injury controls. CT imaging showed that the sham injury group also had small brain lesions suggesting that a more optimal control in TBI research is to perform no craniotomy. No single sleep characteristic was predictive of post-traumatic epilepsy although NREM delta power was different in chronic recordings between TBI mice that developed seizures and those that did not. These studies are relevant to further research in TBI models, to develop a sleep biomarker for PTE. The work is also relevant to humans with TBI as monitoring sleep phenotypes may predict risk, but may also help develop therapies to prevent post-traumatic epilepsy.

scholarly journals Post-traumatic epilepsy associations with mental health outcomes in the first two years after moderate to severe TBI: A TBI Model Systems analysis

2017 ◽  
Vol 73 ◽  
pp. 240-246 ◽  
Author(s):  
Shannon B. Juengst ◽  
Amy K. Wagner ◽  
Anne C. Ritter ◽  
Jerzy P. Szaflarski ◽  
William C. Walker ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Outcomes ◽  
Systems Analysis ◽  
Model Systems ◽  
Mental Health Outcomes ◽  
Severe Tbi ◽  
Post Traumatic ◽  
Post Traumatic Epilepsy ◽  
Traumatic Epilepsy

scholarly journals Neuropathophysiological Mechanisms and Treatment Strategies for Post-traumatic Epilepsy

2021 ◽  
Vol 14 ◽  
Author(s):  
Shaunik Sharma ◽  
Grant Tiarks ◽  
Joseph Haight ◽  
Alexander G. Bassuk
Keyword(s):  
Neurovascular Unit ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Synaptic Proteins ◽  
Post Translational Modification ◽  
Response Factors ◽  
Severe Tbi ◽  
Post Traumatic ◽  
Post Traumatic Epilepsy ◽  
Traumatic Epilepsy

Traumatic brain injury (TBI) is a leading cause of death in young adults and a risk factor for acquired epilepsy. Severe TBI, after a period of time, causes numerous neuropsychiatric and neurodegenerative problems with varying comorbidities; and brain homeostasis may never be restored. As a consequence of disrupted equilibrium, neuropathological changes such as circuit remodeling, reorganization of neural networks, changes in structural and functional plasticity, predisposition to synchronized activity, and post-translational modification of synaptic proteins may begin to dominate the brain. These pathological changes, over the course of time, contribute to conditions like Alzheimer disease, dementia, anxiety disorders, and post-traumatic epilepsy (PTE). PTE is one of the most common, devastating complications of TBI; and of those affected by a severe TBI, more than 50% develop PTE. The etiopathology and mechanisms of PTE are either unknown or poorly understood, which makes treatment challenging. Although anti-epileptic drugs (AEDs) are used as preventive strategies to manage TBI, control acute seizures and prevent development of PTE, their efficacy in PTE remains controversial. In this review, we discuss novel mechanisms and risk factors underlying PTE. We also discuss dysfunctions of neurovascular unit, cell-specific neuroinflammatory mediators and immune response factors that are vital for epileptogenesis after TBI. Finally, we describe current and novel treatments and management strategies for preventing PTE.

scholarly journals Summary of clinical characteristics of common primary adrenal malignancies in adults

2020 ◽  
Author(s):  
zongzong zhang ◽  
lina wang ◽  
xiunan li ◽  
xishuang song ◽  
xuejian wang ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Treatment Options ◽  
Cancer Specific Survival ◽  
Factors Affecting ◽  
Chemotherapy Group ◽  
Radiotherapy Group ◽  
Cox Proportional Hazard ◽  
Surgery Group ◽  
Kaplan Meier ◽  
Significant Difference

Abstract Background To summary the clinical characteristics of common primary adrenal malignancies in adults, the survival time of the patients, and the prognostic factors associated with these rare malignancies. Methods The Surveillance, Epidemiology, and End Results database (1975–2016) was queried for all patients who were diagnosed with primary adrenal malignancies, including adrenocortical carcinoma(ACC), pheochromocytoma and paraganglioma (PPGL), lymphoma, and sarcoma (SA). The clinical characteristics, overall survival (OS) and cancer-specific survival (CSS) were analyzed, in which propensity score methodology, logistic regression modeling and Kaplan-Meier survival curves were used. The Multivariate Cox proportional hazard model was used to identify factors affecting the prognosis of patients with ACC. Results 3204 patients with primary adrenal malignancies were identified, including 2180 with ACC, 593 with PPGL, 307 with lymphoma, and 124 with SA. Generally, PPGL had a better prognosis than others. For ACC and PPGL, the non-metastatic group had better OS and CSS than the metastatic group; for SA, the non-metastatic group had better OS, however, there was no significant difference in CSS between the two groups. Furthermore, For ACC, the single metastasis group had a better OS than the multiple metastasis group. After tumors metastasis, the surgery group, surgery of primary adrenal lesions, had better OS and CSS than the non-surgery group for ACC and PPGL. For lymphoma, the chemotherapy group had better OS and CSS; for ACC and PPGL, the chemotherapy group had better CSS and worse OS; for SA, the survival showed no significant difference between the two groups. Radiotherapy had the same effect on patients' survival as chemotherapy, except for the lymphoma and the ACC. As for lymphoma, the radiotherapy group had better CSS, whereas the survival showed no significant difference in OS between the two groups. For ACC, the non- radiotherapy group had better CSS and OS. More importantly, for lymphoma, under the condition that both cohorts were the same basically, the surgical group had a better prognosis. The prognosis of ACC was related to sex, age, seer historic stage, surgery, chemotherapy. Conclusion Understanding the clinical characteristics of these tumors and factors affecting prognosis can facilitate the selection of more appropriate clinical treatment options.

scholarly journals Post-traumatic epilepsy in adults: a nationwide register-based study

2021 ◽  
pp. jnnp-2020-325382
Author(s):  
Markus Karlander ◽  
Johan Ljungqvist ◽  
Johan Zelano
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Cerebral Injury ◽  
Kaplan Meier ◽  
National Patient ◽  
Post Traumatic ◽  
Multivariable Analyses ◽  
Male Sex ◽  
Post Traumatic Epilepsy ◽  
Traumatic Epilepsy

ObjectiveTraumatic brain injury (TBI) is a leading cause of epilepsy. Our aim was to characterise the risk of epilepsy in adults after hospitalisation for TBI.MethodsRegister-based cohort study. All individuals aged 18–100 with a first hospitalisation for TBI in the comprehensive national patient register in Sweden between 2000 and 2010 (n=111 947) and three controls per exposed (n=325 881), matched on age and sex were included. Exposed individuals were categorised according to TBI severity. Kaplan-Meier curves were used to estimate the risk of epilepsy and Cox regression to estimate the hazard in univariate or multivariate regression.ResultsThe 10-year risk of epilepsy was 12.9% (95% CI 11.7% to 14.1%) for focal cerebral injuries, 8.1% (95% CI 7.5% to 8.7%) for diffuse cerebral injuries, 7.3% (95% CI 6.9% to 7.7%) for extracerebral injuries, 2.8% (95% CI 2.4% to 3.2%) for skull fractures and 2.6% (95% CI 2.4% to 2.8%) for mild TBI. The risk of epilepsy after any TBI was 4.0% (95% CI 3.8% to 4.2%). The corresponding 10-year risk for controls was 0.9% (95% CI 0.9% to 0.9%). The HR increased with a more severe injury, from 3.0 (95% CI 2.8 to 3.2) for mild injury to 16.0 (95% CI 14.5 to 17.5) for focal cerebral injury. Multivariable analyses identified central nervous system (CNS) comorbidities as risk factors, but TBI remained significant also after adjustment for these. Other identified risk factors were male sex, age, mechanical ventilation and seizure during index hospitalisation.ConclusionThe risk of post-traumatic epilepsy is considerable, also with adjustments for CNS comorbidities.

Uso de anticonvulsivantes no traumatismo cranioencefálico

2015 ◽  
Vol 23 (1) ◽  
pp. 150-153
Author(s):  
Vinicius Ricieri Ferraz ◽  
Alexandros Theodoros Panagopoulos ◽  
José Carlos Esteves Veiga ◽  
Guilherme Brasileiro de Aguiar
Keyword(s):  
Craniocerebral Trauma ◽  
Post Traumatic ◽  
Post Traumatic Epilepsy ◽  
Traumatic Epilepsy

Objetivo. Verificar as indicações de uso de anticonvulsivantes em pa­cientes vítimas de traumatismo cranioencefálico (TCE), avaliando os malefícios e benefícios do uso de diferentes drogas anticonvulsivan­tes descritas na literatura. Método. Foi realizada revisão de literatu­ra, utilizando as bases de dados MEDLINE e SCIELO, utilizando os termos: “Epilepsia Pós-Traumática”, “Traumatismos Craniocerebrais ”, “Anticonvulsivantes”, “Post-Traumatic Epilepsy”, “Craniocerebral Trauma” e “Anticonvulsants”. Foram incluídos artigos com enfoque tanto no uso profilático quanto terapêutico de drogas anticonvulsi­vantes no TCE. Foram selecionados os artigos mais relevantes entre os anos de 1980 e 2014. Resultados. Vários autores têm estudado o uso de anticonvulsivantes de forma profilática ou terapêutica em vítimas de TCE, demonstrando o risco de desenvolver convulsão pós traumática em relação ao tipo de lesão cerebral apresentada e com a gravidade do trauma. Conclusão. A maior parte dos artigos não demonstra benefício em se realizar profilaxia anticonvulsivante por mais de sete dias após o trauma. Mais estudos randomizados com uma amostra significativa de pacientes poderiam ser conduzidos no intui­to de comparar o efeito de diferentes drogas anticonvulsivantes tanto na profilaxia quanto no tratamento da epilepsia pós traumática e seu impacto na qualidade de vida desses pacientes e também na morbi­mortalidade dos mesmos.

Time Interval Between Traumatic Brain Injury And Post Traumatic Epilepsy

2013 ◽  
Vol 21 (2) ◽  
pp. 222-228
Author(s):  
Daniel Garbin Di Luca ◽  
Glenda Corrêa Borges de Lacerda
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
First Year ◽  
Time Interval ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Post Traumatic ◽  
Faster Development ◽  
Post Traumatic Epilepsy ◽  
Traumatic Epilepsy

Introduction. The estimated time interval in which an individual can develop Post Traumatic Epilepsy (PTE) after a traumatic brain injury (TBI) is not clear. Objective. To assess the possible influence of the clinical features in the time interval between TBI and PTE develop­ment. Method. We analyzed retrospectively 400 medical records from a tertiary Brazilian hospital. We selected and reevaluated 50 patients and data was confronted with the time between TBI and PTE devel­opment by a Kaplan-Meier survival analysis. A Cox-hazard regression was also conducted to define the characteristics that could be involved in the latent period of the PTE development. Results. Patients devel­oped PTE especially in the first year (56%). We found a tendency of a faster development of PTE in patients older than 24 years (P<0.0001) and in men (P=0.03). Complex partial seizures evolving to generalized seizures were predominant in patients after moderate (37.7%) and severe (48.8%) TBIs, and simple partial seizures evolving to general­ized seizures in mild TBIs (45.5%). Conclusions. Our data suggest that the first year after a TBI is the most critical period for PTE de­velopment and those males older than 24 years could have a faster development of PTE.

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