Association of Posttraumatic Epilepsy With Long-term Functional Outcomes in Individuals With Severe Traumatic Brain Injury

Matthew Pease; Arka N Mallela; Jonathan Elmer; David O Okonkwo; Lori Shutter; Niravkumar Barot; Jorge Gonzalez-Martinez; James F Castellano

doi:10.1212/WNL.0000000000207183

Association of Posttraumatic Epilepsy With Long-term Functional Outcomes in Individuals With Severe Traumatic Brain Injury

Neurology. 2023 May 9;100(19):e1967-e1975. doi: 10.1212/WNL.0000000000207183. Epub 2023 Mar 22.

Authors

Matthew Pease¹, Arka N Mallela², Jonathan Elmer², David O Okonkwo², Lori Shutter², Niravkumar Barot², Jorge Gonzalez-Martinez², James F Castellano²

Affiliations

¹ From the Departments of Neurosurgery (M.P., A.N., D.O.O., J.G-M.), Neurology (J.E., L.S., N.B., J.F.C.), Critical Care (J.E., L.S.), and Emergency Medicine (J.E.), University of Pittsburgh Medical Center, PA. pease.matthew@gmail.com.
² From the Departments of Neurosurgery (M.P., A.N., D.O.O., J.G-M.), Neurology (J.E., L.S., N.B., J.F.C.), Critical Care (J.E., L.S.), and Emergency Medicine (J.E.), University of Pittsburgh Medical Center, PA.

PMID: 36948595
PMCID: PMC10186228 (available on 2024-05-09)
DOI: 10.1212/WNL.0000000000207183

Abstract

Background and objective: Nearly one-third of patients with severe traumatic brain injury (TBI) develop posttraumatic epilepsy (PTE). The relationship between PTE and long-term outcomes is unknown. We tested whether, after controlling for injury severity and age, PTE is associated with worse functional outcomes after severe TBI.

Methods: We performed a retrospective analysis of a prospective database of patients with severe TBI treated from 2002 through 2018 at a single level 1 trauma center. Glasgow Outcome Scale (GOS) was collected at 3, 6, 12, and 24 months postinjury. We used repeated-measures logistic regression predicting GOS, dichotomized as favorable (GOS 4-5) and unfavorable (GOS 1-3), and a separate logistic model predicting mortality at 2 years. We used predictors as defined by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) base model (i.e., age, pupil reactivity, and GCS motor score), PTE status, and time.

Results: Of 392 patients who survived to discharge, 98 (25%) developed PTE. The proportion of patients with favorable outcomes at 3 months did not differ between those with and without PTE (23% [95% Confidence Interval [CI]: 15%-34%] vs 32% [95% CI: 27%-39%]; p = 0.11) but was significantly lower at 6 (33% [95% CI: 23%-44%] vs 46%; [95% CI: 39%-52%] p = 0.03), 12 (41% [95% CI: 30%-52%] vs 54% [95% CI: 47%-61%]; p = 0.03), and 24 months (40% [95% CI: 47%-61%] vs 55% [95% CI: 47%-63%]; p = 0.04). This was driven by higher rates of GOS 2 (vegetative) and 3 (severe disability) outcomes in the PTE group. By 2 years, the incidence of GOS 2 or 3 was double in the PTE group (46% [95% CI: 34%-59%]) compared with that in the non-PTE group (21% [95% CI: 16%-28%]; p < 0.001), while mortality was similar (14% [95% CI: 7%-25%] vs 23% [95% CI: 17%-30%]; p = 0.28). In multivariate analysis, patients with PTE had lower odds of favorable outcome (odds radio [OR] 0.1; 95% CI: 0.1-0.4; p < 0.001), but not mortality (OR 0.9; 95% CI: 0.1-1.9; p = 0.46).

Discussion: Posttraumatic epilepsy is associated with impaired recovery from severe TBI and poor functional outcomes. Early screening and treatment of PTE may improve patient outcomes.

MeSH terms

Brain Injuries, Traumatic* / therapy
Epilepsy* / complications
Glasgow Outcome Scale
Humans
Prognosis
Retrospective Studies