Emergency Medicine

Predictors of Seizures After Trauma

By Nitin K Sethi, MD
Assistant Professor of Neurology, Weill Cornell Medical College

Dr. Sethi reports no financial disclosures relevant to this field of study.

SYNOPSIS: A large prospective study finds that among trauma patients the most important factor linked to post-traumatic seizures was alcohol intoxication.

SOURCE: Vaaramo K, et al. Predictors of new-onset seizures: A 10-year follow-up of head trauma subjects with and without traumatic brain injury. J Neurol Neurosurg Psychiatry 2014;85:598-602.

According to recent findings, both military and civilian cases of traumatic brain injury have been increasingly prevalent. In the United States alone, there are an estimated 2.5 million civilian cases of traumatic brain injury yearly. Moreover, mild traumatic brain injury has been deemed the signature injury of the war on terror, with many soldiers returning from Iraq or Afghanistan afflicted with signs of traumatic brain injury. Seizures have long been understood to follow head injury, particularly in cases of moderate to severe traumatic brain injury. In immediate and early post-traumatic epilepsy (PTE), seizures typically occur soon after first incidence of head trauma; however, there are certain cases in which epileptic onset is delayed, and seizures can occur as far as five to 20 years after the traumatic injury. Risk factors for PTE include advanced age, post-traumatic amnesia lasting more than 24 hours, loss of consciousness of more than 30 minutes, as well as many head injuries including subdural hematoma, brain contusion, epidural hematoma, intracranial hemorrhage, and depressed skull fracture.

The trial authors studied a cohort of 739 trauma patients to analyze the risk factors associated with new-onset seizures. Three hundred and sixty-two of the patients did not have signs of traumatic brain injury, 297 had mild traumatic brain injury, and 80 patients demonstrated moderate-to-severe brain injury. Patients with prior histories of seizures stroke or other neurological diseases were excluded at the outset of the study. Forty-two of the patients studied developed new-onset seizure(s), of which 19 (45.2%) were alcohol-related. Alcohol-related seizure was most common among subjects without traumatic brain injury. Moderate-severe traumatic brain injury patients were more likely to develop PTE and had a higher rate of mortality. As such, moderate-to-severe traumatic brain injury was determined to be an independent predictor of new-onset seizure, along with preceding psychiatric disease and alcohol-related head injury.