Post-traumatic seizures-A prospective study from a tertiary level trauma center in a developing country

Abstract

Rationale: No large studies till date are available from India on post-traumatic seizures (PTS).

Methods: This is a prospective observational study of 520 patients with traumatic brain injury (TBI) (July 2007-2008). Patients admitted after 24h of injury, with Glasgow coma scale (GCS)<or=4 were excluded.

Results: At a median follow-up of 386 days, 59 (11.4%) patients developed PTS. Incidence of immediate, early and late onset seizure were 6.5%, 2.1% and 2.7% respectively. In children, incidence of PTS was 18.3%. On univariate analysis, females, of age <10 years, with associated medical problems and with delayed loss of consciousness and poor GCS (<9), following fall from height, had significantly higher odds of PTS. On multivariate analysis, the risk of PTS was 3.7 times higher in patients who had fallen from height, 4.4 times higher in associated medical problems, and 3.7 times higher in severe head injury (GCS<9) at presentation. PTS was associated with poor Glasgow outcome score and higher incidence of behavioral abnormality on follow up. 32% patient with PTS developed recurrent delayed seizures. Seizure recurrence was significantly higher in late onset PTS. PTS affected overall outcome of the patients in severe head injury.

Conclusion: The risk of PTS was higher in patients who sustained fall from height, in GCS<9, and associated medical problems. About 1/3rd of the patients with early PTS developed recurrent delayed seizures.