Instructor of Neurology University of Pennsylvania
Rationale: Post-traumatic epilepsy (PTE) is a common complication of traumatic brain injury (TBI); however, little is known about the relationship of PTE to recovery from TBI. We describe the prevalence, risk factors, and relationship of PTE to functional outcomes in a large, prospectively collected TBI cohort. Methods: Demographic, imaging, and clinical information were collected as part of the prospective, multi-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (TRACK-TBI). Subjects included those with TBI as well as controls with orthopedic injuries and uninjured peers of TBI participants. Exclusion criteria included age < 18 and pre-existing diagnosis of epilepsy. We identified subjects with a self-report diagnosis of PTE using the National Institute of Neurological Disorders and Stroke Epilepsy Screening Questionnaire (NINDS-ESQ) administered at six and 12 months after injury. Rank regression and propensity-score matching were used to compare 12-month scores on the Glasgow Outcome Scale Extended (GOSE), Rivermead Postconcussion Questionnaire (RPQ) and Brief Symptom Inventory-18 (BSI) in subjects with vs. without self-reported PTE. Results: Among 1885 subjects (1493 TBI, 392 controls) with follow-up information at 12 months; 41 (2.7%) with TBI and 0 (0%) controls screened positive for PTE. There was a significant association between self-reported PTE and injury severity, assessed by presenting GCS and positive findings on acute head computed tomography. After controlling for age, initial GCS, and acute imaging findings subjects with PTE had significantly lower GOSE scores (7.0 vs. 4.6; p< 0.001), and higher BSI (49.0 vs. 56.0; p=0.012), and RPQ (2.8 vs. 4.9; p< 0.001) at 12 months using a rank-regression model. Similar results were obtained using propensity score-matching. Conclusions: The NINDS-ESQ appears to be a valid tool for assessing late post-traumatic seizures. Even after accounting for injury severity, PTE appears to be an independent risk factor for unfavorable outcome. Funding: Please list any funding that was received in support of this abstract.: Supported by NINDS U01NS086090, DoD W81XWH-14-2-0176, W81XWH-12-2-0139, W81XWH-18-2-0042, W81XWH-19-1-0861 (EPI 180013).
