[Risk factors for posttraumatic fits and epilepsy]

There is still a considerable controversy about the usefulness of antiepileptic prophylaxis after traumatic brain injury. Overall incidence of posttraumatic fits and epilepsy's is well known, but an individual decision on prophylaxis requires knowledge about the individual risk. We performed a prospective observational study on 612 patients with traumatic brain injury of every degree of severity. Follow-up by phone call included 96.2% of the study population after 6 month and 91.2% after 36 month, respectively. The overall incidence for early fits (within 7 days after trauma), late fits (up to 36 month) and epilepsy (as defined by the International League Against Epilepsy) was 4.2%, 3.7% and 2.5%, respectively. These incidences increased according to the severity of the trauma, but the most powerful single predictor was intracranial hemorrhage. There was no significant difference related to the hemorrhage localisation. Development of epilepsy was much more common after late fits (48%) than after early fits (17%). These features established a hierarchy of risks for the development of epilepsy: no intracranial hemorrhage/no fit: 1% (4/437), intracranial hemorrhage/no fit: 8% (10/122), intracranial hemorrhage/early fit: 16% (3/19), intracranial hemorrhage/late fit: 53% (7/13). If prophylactic antiepileptic treatment is desired, but should be restricted to patients at high risk. These are patients with intracranial hemorrhage--are a well defined high risk group--when their first fit is a late fit.