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Published on: June 21, 2019
Associations Between Post-traumatic Seizures, Antiseizure Medication, and Duration of Post-traumatic Amnesia: A
Sergiu Albu1, Oyku Arslantas2, Hatice Kumru1
1Neurology Department, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Barcelona, Spain; Universitat Autónoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain.
Objective:
To evaluate the relationship between post-traumatic seizure (PTS) and antiseizure medications (ASMs) use with post-traumatic amnesia (PTA) duration.
Design:
Retrospective study.
Setting:
Neurorehabilitation Hospital.
Participants:
Patients with PTA after traumatic brain injury (TBI) admitted for rehabilitation between February 2002 and May 2024.
Interventions:
Not applicable.
Main Outcome Measures:
Age, sex, Glasgow Coma Scale score, Galveston Orientation and Amnesia Test (GOAT) scores at admission and discharge, presence of PTS and ASM use, and PTA duration (d from TBI to PTA emergence). Group comparisons were conducted between patients with or without PTS and ASM use to identify differences in clinically relevant variables related with PTA duration. Cox proportional-hazards models were conducted to estimate PTA duration.
Results:
A total of 352 patients (80.4% men; median age: 39.54y) were distributed into 4 groups: Treatment-PTS (N=64, ASM for PTS), Prophylactic-ASM (N=46, ASM to prevent PTS), Behavior/Pain-ASM (N=160, ASM for behavioral impairment or neuropathic pain but no PTS), and no-ASM (N=82). Median PTA duration was shortest in no-ASM (59.1d [interquartile range {IQR}, 48.6-89.7]) compared with Treatment-PTS (74.7 [IQR, 55.5-111.5]), Prophylactic-ASM (84.5 [IQR, 59.0-102.2]), and Behavior/Pain-ASM (78.1 [IQR, 56.6-102.5]) (P=.02). Older age (hazard ratio [HR]: 0.98; 95% CI, 0.98-0.99), lower admission GOAT scores (HR, 1.02; 95% CI, 1.02-1.03), and being on Treatment for PTS as compared with no-ASM (HR, 0.58; 95 % CI, 0.38-0.88) or Behavior/Pain-ASM (HR, 0.61; 95 % CI, 0.42-0.89) had significant negative association with the PTA duration.
Conclusions:
ASM use, older age, and lower GOAT score are associated with longer PTA duration. The high use rates of ASMs in patients with TBI extending beyond those with PTS underscores the importance of careful evaluation of ASM use to optimize outcomes in patients with TBI with PTA.
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