Archives of Physical Medicine and Rehabilitation
Volume 78, Issue 8 , Pages 835-840, August 1997

Risk of seizure recurrence after the first late posttraumatic seizure☆☆☆

  • Alan M. Haltiner, PhD

      Affiliations

    • Department of Rehabilitation Medicine, University of Washington, Seattle, USA
    • ,
  • Nancy R. Temkin, PhD

      Affiliations

    • Department of Neurological Surgery, University of Washington, Seattle, USA
    • Department of Biostatistics, University of Washington, Seattle, USA
    • ,
  • Sureyya S. Dikmen, PhD

      Affiliations

    • Corresponding Author InformationReprint requests to Sureyya Dikmen, PhD, Department of Rehabilitation Medicine, University of Washington, Box 356490, Seattle, WA 98195-6490.
    • Department of Rehabilitation Medicine, University of Washington, Seattle, USA
    • Department of Neurological Surgery, University of Washington, Seattle, USA
    • Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA

Received 30 August 1996; accepted 20 January 1997.

Abstract 

Objective: To determine the incidence and risk factors for seizure recurrence after the onset of late posttraumatic seizures (ie, seizures occurring more than 7 days after injury).

Design: Longitudinal cohort design.

Setting: Level 1 trauma center.

Patients: Sixty-three moderately to severely head-injured adults who developed late posttraumatic seizures during the course of their participation in a randomized, placebo-controlled study of the effectiveness of prophylactic phenytoin (Dilantin®) for prevention of posttraumatic seizures.

Main Outcome Measures: Time from the first unprovoked late seizure to time of seizure recurrence.

Results: The cumulative incidence of recurrent late seizures was 86% by approximately 2 years. However, the frequency of recurrent seizures varied considerably across subjects: 52% experienced at least five late seizures, and 37% had 10 or more late seizures within 2 years of the first late seizure. The relative risk of recurrence was highest in patients with a history of acute subdural hematoma and prolonged coma (ie, longer than 7 days).

Conclusions: When late seizures develop after severe head injury, the probability of recurrence is high, which suggests that patients be treated aggressively with anticonvulsant medication after a first unprovoked late seizure.

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☆ Supported by grant NS 19643 from the National Institutes of Neurologic Disorders and Stroke, grant HD 07424 from the National Center for Medical Rehabilitation Research, and grant HS06497 from the Agency for Health Care Policy and Research.

☆☆ No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

PII: S0003-9993(97)90196-9

Archives of Physical Medicine and Rehabilitation
Volume 78, Issue 8 , Pages 835-840, August 1997

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