Quantitative epileptiform burden and electroencephalography background features predict post-traumatic epilepsy

Post-traumatic epilepsy (PTE) is a severe complication of traumatic brain injury (TBI). Electroencephalography aids early post-traumatic seizure diagnosis, but its optimal utility for PTE prediction remains unknown. We aim to evaluate the contribution of quantitative electroencephalograms to predict first-year PTE (PTE₁).

We performed a multicentre, retrospective case-control study of patients with TBI. 63 PTE₁ patients were matched with 63 non-PTE₁ patients by admission Glasgow Coma Scale score, age and sex. We evaluated the association of quantitative electroencephalography features with PTE₁ using logistic regressions and examined their predictive value relative to TBI mechanism and CT abnormalities.

In the matched cohort (n=126), greater epileptiform burden, suppression burden and beta variability were associated with 4.6 times higher PTE₁ risk based on multivariable logistic regression analysis (area under the receiver operating characteristic curve, AUC (95% CI) 0.69 (0.60 to 0.78)). Among 116 (92%) patients with available CT reports, adding quantitative electroencephalography features to a combined mechanism and CT model improved performance (AUC (95% CI), 0.71 (0.61 to 0.80) vs 0.61 (0.51 to 0.72)).

Epileptiform and spectral characteristics enhance covariates identified on TBI admission and CT abnormalities in PTE₁ prediction. Future trials should incorporate quantitative electroencephalography features to validate this enhancement of PTE risk stratification models.