Posttraumatic Seizures in a Rural Nigerian Neurosurgical Service

Traumatic brain injury (TBI) is a recognized risk factor for seizures. In Nigeria, there is paucity of literature on posttraumatic seizure (PTS). This study provides the profile and pattern of PTS in patients with TBI in a rural Nigerian neurosurgical service.

A prospective observational study of patients with TBI was performed. Clinical and radiological data including outcomes of care were analyzed with SPSS version 15. A P value of <0.05 was considered statistically significant.

A total of 199 patients were managed for TBI. There were 20 (10.1%) cases of PTS. Mean age was 28.4 years (range: 5-80 years) and most were male (n = 16; 80%). The average admission Glasgow Coma Scale score was 10 (range: 3-15). Of the 20 patients with PTS, 10 (50%) had mild head injury whereas 3 (15%) and 7 (35%) had moderate and severe head injuries, respectively. PTS peaked in young patients aged 17-45 years (n = 14, 70%). Fourteen (n = 14, 70%) had immediate PTS, whereas 6 (30%) had early PTS. Increasing severity of head injury resulted in a greater incidence of PTS (7.8%, 10.3%, and 17.1% for mild, moderate, and severe head injuries, respectively). Findings of acute subdural hematoma and contusions on computed tomography scan are significant risk factors for PTS (χ²: 22.8; P value: 0.0004). Five (25%) patients required anticonvulsant therapy because of seizure recurrence, but only one progressed to late PTS. Four (20.0%) died, whereas the rest had good outcome.

Severe TBI and computed tomography findings of acute subdural hematoma and cerebral contusions are predictors of PTS in our environment. Progression of immediate/early to late PTS is rare.