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.

Article Outline

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.

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Caveness WF, Meirowsky AM, Rish BL, Mohr JP, Kistler JP, Dillon JD, et al.  The nature of posttraumatic epilepsy. J Neurosurg. 1979;50:545–553
  2. Jennett B. Epilepsy after non-missile head injuries. 2nd ed.. Chicago: Year Book Medical Publishers Inc; 1975;
  3. Salazar AM, Jabbari B, Vance SC, Grafman J, Amin D, Dillon JD. Epilepsy after penetrating head injury. I. Clinical correlates: a report of the Vietnam Head Injury Study. Neurology. 1985;35:1406–1414
  4. Koehler J. Risk of late unprovoked seizures in patients with moderate/severe head injuries. [Master's thesis] Seattle: Univ. of Washington; 1994;
  5. Dikmen SS, Temkin N, Miller B, Machamer J, Winn HR. Neurobehavioral effects of phenytoin prophylaxis of posttraumatic seizures. JAMA. 1991;265:1271–1277
  6. Caveness WF. Onset and cessation of fits following craniocerebral trauma. J Neurosurg. 1963;20:570–583
  7. Weiss GH, Caveness WF. Prognostic factors in the persistence of posttraumatic epilepsy. J Neurosurg. 1972;37:164–169
  8. Temkin N, Dikmen SS, Wilensky AJ, Keihm J, Chabal S, Winn HR. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med. 1990;323:497–502
  9. Jennett B, Teasdale G. Management of head injuries. In: 2nd ed.. Contemporary Neurology Series. Vol 20:Philadelphia: F.A. Davis; 1981;
  10. Cox DR. Regression models and life-tables. J R Stat Soc [B]. 1972;34:187–202
  11. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481
  12. Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology. 1990;41:965–972
  13. Bora I, Seckin B, Zarifoglu M, Turan F, Sadlkoglu S, Ogul E. Risk of recurrence after first unprovoked tonic-clonic seizure in adults. J Neurol. 1995;242:157–163
  14. Cleland PG, Mosquera I, Steward WP, Foster JB. Prognosis of isolated seizures in adult life. BMJ Research Ed. 1981;283:1364
  15. Hopkins A, Garman A, Clarke C. The first seizure in adult life: value of clinical features, electroencephalography, and computerized tomographic scanning in prediction of seizure recurrence. Lancet. 1988;1:721–726
  16. Saunders M, Marshall C. Isolated seizures: an EEG and clinical assessment. Epilepsia. 1975;16:731–733
  17. van Donselaar CA, Schimsheimer R-J, Geerts AT, Declerck AC. Value of the electroencephalogram in adult patients with untreated idiopathic first seizures. Arch Neurol. 1992;49:231–237
  18. Hammond EJ, Ramsay RE, Villareal HJ, Wilder BJ. Effects of intracortical injections of blood and blood components on the electrocorticogram. Epilepsia. 1980;21:3–14

☆ 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

Article Tools