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. 2025 Sep:170:110487.
doi: 10.1016/j.yebeh.2025.110487. Epub 2025 May 20.

Predictive factors and prevalence of acute symptomatic seizures among patients with acute traumatic brain injuries

Konstantin Kohlhase  1 , Adam Strzelczyk  2 , Laurent M Willems  2 , Luis Mandelka  3 , Sarah C Reitz  4 , Marcus Czabanka  5 , Moritz Funke  6 , Christian Grefkes  3 , Ingo Marzi  7 , Cora Schindler  7 , Ferdinand O Bohmann  3
Affiliations
Free article

Predictive factors and prevalence of acute symptomatic seizures among patients with acute traumatic brain injuries

Konstantin Kohlhase et al. Epilepsy Behav. 2025 Sep.
Free article

Abstract

Introduction: Traumatic brain injuries (TBI) significantly contribute to hospital admissions in Europe. Acute symptomatic seizures (ASz), occurring within seven days post-TBI, increase morbidity and mortality. This study analyzes the frequency, risk factors, and short-term outcomes of ASz in patients with acute TBI.

Material and methods: This retrospective study included 212 patients with acute TBI admitted to the University Hospital Frankfurt/Germany between 2018 and 2021. Data were collected on demographics, injury characteristics, clinical course, and outcomes. ASz were defined as clinically or electroencephalographically detected seizures within seven days post-TBI. Logistic regression was used to identify predictors of ASz and non-convulsive status epilepticus (NCSE).

Results: ASz occurred in 17.9 % (n = 38) of patients, with a mean latency of 2.4 ± 1.9 days post-TBI. Status epilepticus developed in 47.4 % (n = 18) of these patients, predominantly as NCSE (n = 15). Predictors of ASz included older age (OR = 1.034, p = 0.012), higher Glasgow Coma Scale (GCS) at 24 h (OR = 1.133, p = 0.021), severe TBI (OR = 5.085, p = 0.018), and pneumonia (OR = 5.828, p = 0.007). For NCSE, significant predictors were older age (OR = 1.059, p = 0.021), pneumonia (OR = 6.766, p = 0.012), and urinary tract infection (OR = 7.38, p = 0.012). Patients with ASz had a significantly worse modified Rankin Scale (mRS) score at discharge (OR = 5.01, CI: 1.93-13.0, p < 0.001)).

Conclusion: ASz are a frequent and serious complication of TBI, particularly in severe cases and older patients. Early identification of high-risk patients using predictive factors such as age, GCS, and pneumonia may result in earlier treatment and improved outcomes. The findings highlight the importance of dedicated epilepsy monitoring in acute TBI care.

Keywords: EEG; Intensive care unit; Neurology; Neurosurgery; Status epilepticus; Trauma.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Konstantin Kohlhase reports a relationship with Merck Healthcare Germany GmbH that includes: funding grants. Adam Strzekczyk reports honoraria or research funding from Angelini Pharma, Biocodex, Desitin Arzneimittel, Eisai, Jazz Pharmaceuticals, Neuraxpharm, Takeda, UCB Pharma, and UNEEG medical. Sarah C. Reitz reports a relationship with AstraZeneca that includes: speaking and lecture fees. Ferdinand O. Bohmann reports a relationship with Laerdal, AstraZeneca, Bristol-Myers-Squibb, Pfizer, Medtronic that includes: speaking and lecture fees. Ferdinand O. Bohmann reports a relationship with Alexion, AstraZeneca, Stryker Neurovascular, and Boehringer Ingelheim that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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