Risk Factors and Outcomes of Late Posttraumatic Seizures in Combat-Related Traumatic Brain Injury

Area of Science:

• Neurology
• Trauma Surgery
• Military Medicine

Background:

• Post-traumatic seizures (PTSs) are a significant cause of morbidity following traumatic brain injury (TBI).
• While early PTS are infrequent in combat casualties, the incidence of late PTS remains understudied.
• This study aimed to determine the prevalence and risk factors for late PTS in military personnel with TBI.

Purpose of the Study:

• To define the prevalence of late post-traumatic seizures (PTSs) in combat casualties with traumatic brain injury (TBI).
• To identify risk factors associated with the development of late PTS after TBI in a military cohort.
• To evaluate the impact of late PTS on patient outcomes.

Main Methods:

• Analysis of 687 combat casualties from the Department of Defense Trauma Registry (2010-2015).
• Inclusion of 71 patients with radiographic evidence of TBI for detailed analysis.
• Collection of data on demographics, injury characteristics, interventions, medications, and outcomes, with a median follow-up of 7.4 years.

Main Results:

• No early PTS were observed; 25.8% of patients developed late PTS.
• Late PTS patients had higher Injury Severity Scores (30 vs. 24) and required more blood products (18 vs. 2 units).
• Penetrating TBI (76.5% vs. 38.8%), multiple intracranial hemorrhages (94.1% vs. 63.3%), and cranial decompression (76.5% vs. 28.6%) were significantly associated with late PTS.

Conclusions:

• Combat casualties with TBI experiencing late PTS have more severe injuries and require greater blood product transfusion.
• Penetrating TBI, intracranial hemorrhage, and cranial decompression are key risk factors for late PTS.
• Prophylactic antiepileptic drug (AED) administration for early PTS did not influence the rate of late PTS.