Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study

Anne C. Ritter, Amy K. Wagner, Anthony Fabio, Mary Jo Pugh, William C. Walker, Jerzy P. Szaflarski, Ross D. Zafonte, Allen W. Brown, Flora Hammond, Tamara Bushnik, Douglas Johnson-Greene, Timothy Shea, Jason W. Krellman, Joseph A. Rosenthal, Laura E. Dreer

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective: Determine incidence of posttraumatic seizure (PTS) following traumatic brain injury (TBI) among individuals with moderate-to-severe TBI requiring rehabilitation and surviving at least 5 years. Methods: Using the prospective TBI Model Systems National Database, we calculated PTS incidence during acute hospitalization, and at years 1, 2, and 5 postinjury in a continuously followed cohort enrolled from 1989 to 2000 (n = 795). Incidence rates were stratified by risk factors, and adjusted relative risk (RR) was calculated. Late PTS associations with immediate (<24 h), early (24 h-7 day), or late seizures (>7 day) versus no seizure prior to discharge from acute hospitalization was also examined. Results: PTS incidence during acute hospitalization was highest immediately (<24 h) post-TBI (8.9%). New onset PTS incidence was greatest between discharge from inpatient rehabilitation and year 1 (9.2%). Late PTS cumulative incidence from injury to year 1 was 11.9%, and reached 20.5% by year 5. Immediate/early PTS RR (2.04) was increased for those undergoing surgical evacuation procedures. Late PTS RR was significantly greater for individuals who self-identified as a race other than black/white (year 1 RR = 2.22), and for black individuals (year 5 RR = 3.02) versus white individuals. Late PTS was greater for individuals with subarachnoid hemorrhage (year 1 RR = 2.06) and individuals age 23-32 (year 5 RR = 2.43) and 33-44 (year 5 RR = 3.02). Late PTS RR years 1 and 5 was significantly higher for those undergoing surgical evacuation procedures (RR: 3.05 and 2.72, respectively). Significance: In this prospective, longitudinal, observational study, PTS incidence was similar to that in studies published previously. Individuals with immediate/late seizures during acute hospitalization have increased late PTS risk. Race, intracranial pathologies, and neurosurgical procedures also influenced PTS RR. Further studies are needed to examine the impact of seizure prophylaxis in high-risk subgroups and to delineate contributors to race/age associations on long-term seizure outcomes.

Original languageEnglish (US)
JournalEpilepsia
DOIs
StateAccepted/In press - 2016

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Seizures
Incidence
Hospitalization
Traumatic Brain Injury
Rehabilitation
Post-Traumatic Epilepsy
Neurosurgical Procedures
Subarachnoid Hemorrhage
Observational Studies
Longitudinal Studies
Inpatients
Databases
Pathology

Keywords

  • Epidemiology
  • Epilepsy
  • Prophylaxis
  • Relative risk
  • TBI Model Systems

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Ritter, A. C., Wagner, A. K., Fabio, A., Pugh, M. J., Walker, W. C., Szaflarski, J. P., ... Dreer, L. E. (Accepted/In press). Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study. Epilepsia. https://doi.org/10.1111/epi.13582

Incidence and risk factors of posttraumatic seizures following traumatic brain injury : A Traumatic Brain Injury Model Systems Study. / Ritter, Anne C.; Wagner, Amy K.; Fabio, Anthony; Pugh, Mary Jo; Walker, William C.; Szaflarski, Jerzy P.; Zafonte, Ross D.; Brown, Allen W.; Hammond, Flora; Bushnik, Tamara; Johnson-Greene, Douglas; Shea, Timothy; Krellman, Jason W.; Rosenthal, Joseph A.; Dreer, Laura E.

In: Epilepsia, 2016.

Research output: Contribution to journalArticle

Ritter, AC, Wagner, AK, Fabio, A, Pugh, MJ, Walker, WC, Szaflarski, JP, Zafonte, RD, Brown, AW, Hammond, F, Bushnik, T, Johnson-Greene, D, Shea, T, Krellman, JW, Rosenthal, JA & Dreer, LE 2016, 'Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study', Epilepsia. https://doi.org/10.1111/epi.13582
Ritter, Anne C. ; Wagner, Amy K. ; Fabio, Anthony ; Pugh, Mary Jo ; Walker, William C. ; Szaflarski, Jerzy P. ; Zafonte, Ross D. ; Brown, Allen W. ; Hammond, Flora ; Bushnik, Tamara ; Johnson-Greene, Douglas ; Shea, Timothy ; Krellman, Jason W. ; Rosenthal, Joseph A. ; Dreer, Laura E. / Incidence and risk factors of posttraumatic seizures following traumatic brain injury : A Traumatic Brain Injury Model Systems Study. In: Epilepsia. 2016.
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abstract = "Objective: Determine incidence of posttraumatic seizure (PTS) following traumatic brain injury (TBI) among individuals with moderate-to-severe TBI requiring rehabilitation and surviving at least 5 years. Methods: Using the prospective TBI Model Systems National Database, we calculated PTS incidence during acute hospitalization, and at years 1, 2, and 5 postinjury in a continuously followed cohort enrolled from 1989 to 2000 (n = 795). Incidence rates were stratified by risk factors, and adjusted relative risk (RR) was calculated. Late PTS associations with immediate (<24 h), early (24 h-7 day), or late seizures (>7 day) versus no seizure prior to discharge from acute hospitalization was also examined. Results: PTS incidence during acute hospitalization was highest immediately (<24 h) post-TBI (8.9{\%}). New onset PTS incidence was greatest between discharge from inpatient rehabilitation and year 1 (9.2{\%}). Late PTS cumulative incidence from injury to year 1 was 11.9{\%}, and reached 20.5{\%} by year 5. Immediate/early PTS RR (2.04) was increased for those undergoing surgical evacuation procedures. Late PTS RR was significantly greater for individuals who self-identified as a race other than black/white (year 1 RR = 2.22), and for black individuals (year 5 RR = 3.02) versus white individuals. Late PTS was greater for individuals with subarachnoid hemorrhage (year 1 RR = 2.06) and individuals age 23-32 (year 5 RR = 2.43) and 33-44 (year 5 RR = 3.02). Late PTS RR years 1 and 5 was significantly higher for those undergoing surgical evacuation procedures (RR: 3.05 and 2.72, respectively). Significance: In this prospective, longitudinal, observational study, PTS incidence was similar to that in studies published previously. Individuals with immediate/late seizures during acute hospitalization have increased late PTS risk. Race, intracranial pathologies, and neurosurgical procedures also influenced PTS RR. Further studies are needed to examine the impact of seizure prophylaxis in high-risk subgroups and to delineate contributors to race/age associations on long-term seizure outcomes.",
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T1 - Incidence and risk factors of posttraumatic seizures following traumatic brain injury

T2 - A Traumatic Brain Injury Model Systems Study

AU - Ritter, Anne C.

AU - Wagner, Amy K.

AU - Fabio, Anthony

AU - Pugh, Mary Jo

AU - Walker, William C.

AU - Szaflarski, Jerzy P.

AU - Zafonte, Ross D.

AU - Brown, Allen W.

AU - Hammond, Flora

AU - Bushnik, Tamara

AU - Johnson-Greene, Douglas

AU - Shea, Timothy

AU - Krellman, Jason W.

AU - Rosenthal, Joseph A.

AU - Dreer, Laura E.

PY - 2016

Y1 - 2016

N2 - Objective: Determine incidence of posttraumatic seizure (PTS) following traumatic brain injury (TBI) among individuals with moderate-to-severe TBI requiring rehabilitation and surviving at least 5 years. Methods: Using the prospective TBI Model Systems National Database, we calculated PTS incidence during acute hospitalization, and at years 1, 2, and 5 postinjury in a continuously followed cohort enrolled from 1989 to 2000 (n = 795). Incidence rates were stratified by risk factors, and adjusted relative risk (RR) was calculated. Late PTS associations with immediate (<24 h), early (24 h-7 day), or late seizures (>7 day) versus no seizure prior to discharge from acute hospitalization was also examined. Results: PTS incidence during acute hospitalization was highest immediately (<24 h) post-TBI (8.9%). New onset PTS incidence was greatest between discharge from inpatient rehabilitation and year 1 (9.2%). Late PTS cumulative incidence from injury to year 1 was 11.9%, and reached 20.5% by year 5. Immediate/early PTS RR (2.04) was increased for those undergoing surgical evacuation procedures. Late PTS RR was significantly greater for individuals who self-identified as a race other than black/white (year 1 RR = 2.22), and for black individuals (year 5 RR = 3.02) versus white individuals. Late PTS was greater for individuals with subarachnoid hemorrhage (year 1 RR = 2.06) and individuals age 23-32 (year 5 RR = 2.43) and 33-44 (year 5 RR = 3.02). Late PTS RR years 1 and 5 was significantly higher for those undergoing surgical evacuation procedures (RR: 3.05 and 2.72, respectively). Significance: In this prospective, longitudinal, observational study, PTS incidence was similar to that in studies published previously. Individuals with immediate/late seizures during acute hospitalization have increased late PTS risk. Race, intracranial pathologies, and neurosurgical procedures also influenced PTS RR. Further studies are needed to examine the impact of seizure prophylaxis in high-risk subgroups and to delineate contributors to race/age associations on long-term seizure outcomes.

AB - Objective: Determine incidence of posttraumatic seizure (PTS) following traumatic brain injury (TBI) among individuals with moderate-to-severe TBI requiring rehabilitation and surviving at least 5 years. Methods: Using the prospective TBI Model Systems National Database, we calculated PTS incidence during acute hospitalization, and at years 1, 2, and 5 postinjury in a continuously followed cohort enrolled from 1989 to 2000 (n = 795). Incidence rates were stratified by risk factors, and adjusted relative risk (RR) was calculated. Late PTS associations with immediate (<24 h), early (24 h-7 day), or late seizures (>7 day) versus no seizure prior to discharge from acute hospitalization was also examined. Results: PTS incidence during acute hospitalization was highest immediately (<24 h) post-TBI (8.9%). New onset PTS incidence was greatest between discharge from inpatient rehabilitation and year 1 (9.2%). Late PTS cumulative incidence from injury to year 1 was 11.9%, and reached 20.5% by year 5. Immediate/early PTS RR (2.04) was increased for those undergoing surgical evacuation procedures. Late PTS RR was significantly greater for individuals who self-identified as a race other than black/white (year 1 RR = 2.22), and for black individuals (year 5 RR = 3.02) versus white individuals. Late PTS was greater for individuals with subarachnoid hemorrhage (year 1 RR = 2.06) and individuals age 23-32 (year 5 RR = 2.43) and 33-44 (year 5 RR = 3.02). Late PTS RR years 1 and 5 was significantly higher for those undergoing surgical evacuation procedures (RR: 3.05 and 2.72, respectively). Significance: In this prospective, longitudinal, observational study, PTS incidence was similar to that in studies published previously. Individuals with immediate/late seizures during acute hospitalization have increased late PTS risk. Race, intracranial pathologies, and neurosurgical procedures also influenced PTS RR. Further studies are needed to examine the impact of seizure prophylaxis in high-risk subgroups and to delineate contributors to race/age associations on long-term seizure outcomes.

KW - Epidemiology

KW - Epilepsy

KW - Prophylaxis

KW - Relative risk

KW - TBI Model Systems

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