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Oboth R, Kamabu LK, Lekuya HM, Bbosa GS, Sajatovic M, Katabira E, Kaddumukasa M, Galukande M. Post-traumatic seizures and factors associated among adult patients with depressed skull fractures at Mulago National Referral hospital; cross-sectional study. Epilepsy Behav 2024; 152:109693. [PMID: 38368722 PMCID: PMC11027507 DOI: 10.1016/j.yebeh.2024.109693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/10/2024] [Accepted: 02/10/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Post-traumatic seizures (PTS) are common among patients with depressed skull fractures (DSF). Understanding the burden of post traumatic seizures and the factors associated among adult patients with DSF is important to improve clinical care. OBJECTIVE To determine the prevalence and factors associated with post-traumatic seizures among adult patients with DSF at Mulago National Referral hospital (MNRH). METHODS A cross-sectional study was conducted among 333 study participants between March 2021 and February 2022. Socio-demographic, clinical laboratory factors and anti-seizure medications were collected using a study questionnaire. Data was analysed to determine the prevalence of PTS and factors associated with occurrence of PTS among patients with DSF. RESULTS The mean age (±SD) of study participants was 31.2, (±10.5) years, with a male to female ratio of 10.4:1. Nearly half of the study participants had attained secondary level of education, while 31.6 % (105) were peasants (subsistence farmers). The overall prevalence of PTS among DSF study participants was 16.2 % (54participants). Late presentation of PTS was the highest at 9.0 % (30) followed by early PTS at 3.9 % [13] and immediate PTS at 3.3 % [11]. Moderate Glasgow coma score (GCS: 9-13), p < 0.015, severe traumatic brain injury (GCS: 3-8), p < 0.026 at the time of admission and midline brain shift (≥5mm), p < 0.009 were associated with PTS. Phenytoin (94.3 %) was the most commonly used ASM followed by phenobarbitone (1.4 %) and Valproate (1.1 %) among study participants. CONCLUSION Patients with moderate and severe traumatic brain injury and midline brain shift were associated with post traumatic seizures. Early identification and intervention may reduce the burden of posttraumatic seizures in this category of patients.
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Affiliation(s)
- Ronald Oboth
- Department of Surgery, School of Medicine, College of Health Sciences, Makerere University Kampala, Uganda.
| | - Larrey Kasereka Kamabu
- Department of Surgery, School of Medicine, College of Health Sciences, Makerere University Kampala, Uganda
| | - Herve M Lekuya
- Department of Surgery, School of Medicine, College of Health Sciences, Makerere University Kampala, Uganda
| | - Godfrey S Bbosa
- Department of Pharmacology and Therapeutics, School of Biomedical Sciences, College of Health Sciences, Makerere University Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Elly Katabira
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Uganda
| | - Mark Kaddumukasa
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Uganda
| | - Moses Galukande
- Department of Surgery, School of Medicine, College of Health Sciences, Makerere University Kampala, Uganda
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Mele C, Pagano L, Franciotta D, Caputo M, Nardone A, Aimaretti G, Marzullo P, Pingue V. Thyroid function in the subacute phase of traumatic brain injury: a potential predictor of post-traumatic neurological and functional outcomes. J Endocrinol Invest 2022; 45:379-389. [PMID: 34351610 PMCID: PMC8783844 DOI: 10.1007/s40618-021-01656-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/29/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE That thyroid hormones exert pleiotropic effects and have a contributory role in triggering seizures in patients with traumatic brain injury (TBI) can be hypothesized. We aimed at investigating thyroid function tests as prognostic factors of the development of seizures and of functional outcome in TBI. METHODS This retrospective study enrolled 243 adult patients with a diagnosis of mild-to-severe TBI, consecutively admitted to our rehabilitation unit for a 6-month neurorehabilitation program. Data on occurrence of seizures, brain imaging, injury characteristics, associated neurosurgical procedures, neurologic and functional assessments, and death during hospitalization were collected at baseline, during the workup and on discharge. Thyroid function tests (serum TSH, fT4, and fT3 levels) were performed upon admission to neurorehabilitation. RESULTS Serum fT3 levels were positively associated with an increased risk of late post-traumatic seizures (LPTS) in post-TBI patients independent of age, sex and TBI severity (OR = 1.85, CI 95% 1.22-2.61, p < 0.01). Measured at admission, fT3 values higher than 2.76 pg/mL discriminated patients with late post-traumatic seizures from those without, with a sensitivity of 74.2% and a specificity of 60.9%. Independently from the presence of post-traumatic epilepsy and TBI severity, increasing TSH levels and decreasing fT3 levels were associated with worse neurological and functional outcome, as well as with higher risk of mortality within 6 months from the TBI event. CONCLUSIONS Serum fT3 levels assessed in the subacute phase post-TBI are associated with neurological and functional outcome as well as with the risk of seizure occurrence. Further studies are needed to investigate the mechanisms underlying these associations.
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Affiliation(s)
- C Mele
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - L Pagano
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - D Franciotta
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Caputo
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - A Nardone
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
| | - G Aimaretti
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - P Marzullo
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Division of General Medicine, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, Verbania, Italy
| | - V Pingue
- Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
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Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury. Sci Rep 2021; 11:4708. [PMID: 33633297 PMCID: PMC7907376 DOI: 10.1038/s41598-021-84203-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/08/2021] [Indexed: 12/15/2022] Open
Abstract
Post-traumatic seizures (PTS) are a common and debilitating complication of traumatic brain injury (TBI) and could have a harmful impact on the progress of patient rehabilitation. To assess the effect of PTS and relative therapy on outcome in the initial phase after TBI, during the rehabilitation process when neuroplasticity is at its highest, we retrospectively examined the clinical data of 341 adult patients undergoing rehabilitation for at least 6 months post-TBI in our neurorehabilitation unit between 2008 and 2019. We correlated through logistic regression the occurrence of seizures and use of anti-seizure medication (ASM) with neurological and functional outcomes, respectively assessed with the Glasgow Coma Scale (GCS) and the Functional Independence Measure (FIM). PTS were documented in 19.4% of patients: early PTS (EPTS) in 7.0%; late PTS (LPTS) in 9.4%; both types in 3.0%. Patients who developed EPTS had an increased risk of developing LPTS (OR = 3.90, CI 95% 1.58–9.63, p = 0.003). Patients with LPTS had a significantly higher risk of worse neurological (p < 0.0001) and rehabilitation (p < 0.05) outcome. Overall, 38.7% of patients underwent therapy with ASM; prophylactic therapy was prescribed in 24.0% of patients, of whom 14.6% subsequently developed seizures. Mortality was associated with a lower FIM and GCS score on admission but not significantly with PTS. The use of ASM was associated with a worse rehabilitation outcome, independently of the onset of epilepsy during treatment. LPTS appear to exert a negative impact on rehabilitation outcome and their occurrence is not reduced by prophylactic therapy, whereas EPTS do not influence outcome. Our findings caution against the generic use of prophylactic therapy to prevent post-traumatic epilepsy in patients with TBI.
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Bussolin L, Falconi M, Leo MC, Parri N, DE Masi S, Rosati A, Cecchi C, Spacca B, Grandoni M, Bettiol A, Lucenteforte E, Lubrano R, Falsaperla R, Melosi F, Agostiniani R, Mangiantini F, Talamonti G, Calderini E, Mancino A, DE Luca M, Conti G, Petrini F. The management of pediatric severe traumatic brain injury: Italian Guidelines. Minerva Anestesiol 2021; 87:567-579. [PMID: 33432789 DOI: 10.23736/s0375-9393.20.14122-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of the work was to update the "Guidelines for the Management of Severe Traumatic Brain Injury" published in 2012, to reflect the new available evidence, and develop the Italian national guideline for the management of severe pediatric head injuries to reduce variation in practice and ensure optimal care to patients. EVIDENCE ACQUISITION MEDLINE and EMBASE were searched from January 2009 to October 2017. Inclusion criteria were English language, pediatric populations (0-18 years) or mixed populations (pediatric/adult) with available age subgroup analyses. The guideline development process was started by the Promoting Group that composed a multidisciplinary panel of experts, with the representatives of the Scientific Societies, the independent expert specialists and a representative of the Patient Associations. The panel selected the clinical questions, discussed the evidence and formulated the text of the recommendations. The documentarists of the University of Florence oversaw the bibliographic research strategy. A group of literature reviewers evaluated the selected literature and compiled the table of evidence for each clinical question. EVIDENCE SYNTHESIS The search strategies identified 4254 articles. We selected 3227 abstract (first screening) and, finally included 67 articles (second screening) to update the guideline. This Italian update includes 25 evidence-based recommendations and 5 research recommendations. CONCLUSIONS In recent years, progress has been made on the understanding of severe pediatric brain injury, as well as on that concerning all major traumatic pathology. This has led to a progressive improvement in the clinical outcome, although the quantity and quality of evidence remains particularly low.
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Affiliation(s)
- Leonardo Bussolin
- Neuroanesthesiology, Intensive Care and Trauma Center, A. Meyer University Hospital, Florence, Italy
| | - Martina Falconi
- Techical-Scientific Secretary, Pediatric Regional and Ethical Committee, A. Meyer University Hospital, Florence, Italy
| | - Maria C Leo
- Techical-Scientific Secretary, Pediatric Regional and Ethical Committee, A. Meyer University Hospital, Florence, Italy
| | - Niccolò Parri
- Emergency Department and Trauma Center, A. Meyer University Hospital, Florence, Italy -
| | - Salvatore DE Masi
- Clinical Trial Office, A. Meyer University Hospital, Florence, Italy
| | - Anna Rosati
- Neurosciences Excellence Center, A. Meyer University Hospital, Florence, Italy
| | - Costanza Cecchi
- Anestesiology and Intensive Care Unit, A. Meyer University Hospital, Florence, Italy
| | - Barbara Spacca
- Unit of Neurosurgery, A. Meyer University Hospital, Florence, Italy
| | - Manuela Grandoni
- Unit of Neurosurgery, A. Meyer University Hospital, Florence, Italy
| | | | | | - Riccardo Lubrano
- Società Italiana di Medicina Emergenza Urgenza Pediatrica (SIMEUP), Milan, Italy.,Pediatrics Unit, Pediatric Emergency Department, Neonatology and Neonatal Intensive Care, "Rodolico-San Marco" University Hospital, Catania, Italy
| | - Raffaele Falsaperla
- Società Italiana di Medicina Emergenza Urgenza Pediatrica (SIMEUP), Milan, Italy.,Pediatrics and Neonatology Unit, Department of Maternal and Urological Sciences, Sapienza University, Latina, Rome, Italy
| | - Francesca Melosi
- Anestesiology and Intensive Care Unit, A. Meyer University Hospital, Florence, Italy.,Società Italiana di Neurosonologia ed Emodinamica Cerebrale (SINSEC), Bologna, Italy
| | | | | | | | - Edoardo Calderini
- Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Rome, Italy
| | - Aldo Mancino
- Società di Anestesia e Rianimazione Neonatale e Pediatrica Italiana (S.A.R.N.eP.I), Rome, Italy
| | - Marco DE Luca
- Accademia Medica ed Infermieristica di Emergenza e Terapia Intensiva Pediatrica (AMIETIP), Bologna, Italy
| | - Giorgio Conti
- Accademia Medica ed Infermieristica di Emergenza e Terapia Intensiva Pediatrica (AMIETIP), Bologna, Italy.,IRCCS A. Gemelli, Catholic University, Rome, Italy
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Pozzi M, Galbiati S, Locatelli F, Carnovale C, Radice S, Strazzer S, Clementi E. Drug Use in Pediatric Patients Admitted to Rehabilitation For Severe Acquired Brain Injury: Analysis of the Associations With Rehabilitation Outcomes. Paediatr Drugs 2021; 23:75-86. [PMID: 33230677 DOI: 10.1007/s40272-020-00429-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Patients with severe acquired brain injuries require drug therapies in intensive care for life support and injury treatment. Patients who then access rehabilitation usually maintain their drug treatments long term, with a potential influence on the rehabilitation course. Whereas drug effects have been reported for specific drugs and clinical issues in adults, comprehensive data on pediatric patients with traumatic and non-traumatic injuries are scant. OBJECTIVES The aims of this study were to describe the therapeutic classes and groups of drugs prescribed to pediatric inpatients recovering from severe acquired brain injury when they enter rehabilitation; to assess whether clinical variables may determine the use of drug classes; and to assess whether the use of drug classes may be associated with differences in rehabilitation outcomes. METHODS We carried out a retrospective chart review, following a previous study on the clinical-epidemiological characteristics of our patients. We collected information on drug therapies present at admittance to rehabilitation and analyzed their distribution according to therapeutic classes and groups. We verified the associations of drug groups with clinical variables (putatively antecedents to drug use) and with rehabilitation outcomes (putatively resultant of drug use and of clinical variables) in regression models. The clinical variables considered were injury etiology, Glasgow Outcome Score (GOS) at admittance to rehabilitation, sex, age at injury, plus two aggregate factors resulting from the previous work, 'neurological dysfunction' regarding the use of devices and 'injury severity' regarding the neurological status. The rehabilitation outcomes used were death after rehabilitation, persistence of a vegetative/minimally conscious state, coma duration, duration of the rehabilitation stay, rehabilitation efficiency (GOS at discharge minus GOS at admittance, divided by the length of rehabilitation stay). RESULTS We described the distribution of drug classes and groups among pediatric patients with severe acquired brain injuries. Regarding the associations between drug classes and clinical variables, we found greater use of cardiovascular agents with higher patient age, 'neurological dysfunction' score, and with an etiology of hypoxic brain injury. The use of antithrombotic agents was greater with higher patient age and 'neurological dysfunction' score. Glucocorticoid use was greater with higher GOS at admittance and with several etiologies: brain tumor, infective encephalitis, and autoimmune encephalitis. Regarding drug classes and rehabilitation outcomes, we found that the use of cardiovascular drugs was associated with increased occurrence of death after rehabilitation. The use of antispastic drugs was associated with a more frequent permanence in vegetative/minimally conscious states. The use of antispastic drugs and melatonin was associated with longer coma duration. The use of glucocorticoid drugs was associated with decreased rehabilitation efficiency. CONCLUSIONS We provided a description of drug use in pediatric rehabilitation after severe acquired brain injuries, which was lacking in the literature. Prospective studies should verify our associative observations regarding clinical variables, drugs use, and outcomes, to assess causality.
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Affiliation(s)
- Marco Pozzi
- U.O. Gravi Cerebrolesioni Acquisite NR3, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Sara Galbiati
- U.O. Gravi Cerebrolesioni Acquisite NR3, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Federica Locatelli
- U.O. Gravi Cerebrolesioni Acquisite NR3, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Sandra Strazzer
- U.O. Gravi Cerebrolesioni Acquisite NR3, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy.
| | - Emilio Clementi
- U.O. Gravi Cerebrolesioni Acquisite NR3, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy.,Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
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Pringle C, Bailey M, Bukhari S, El-Sayed A, Hughes S, Josan V, Ramirez R, Kamaly-Asl I. Manchester Arena Attack: management of paediatric penetrating brain injuries. Br J Neurosurg 2020; 35:103-111. [PMID: 32677863 DOI: 10.1080/02688697.2020.1787339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The Manchester Arena bombing on 22 May 2017 resulted in 22 deaths and over 160 casualties requiring medical attention. Given the threat of modern- era terrorist attacks in civilian environments, it is important that we are able to anticipate and appropriately manage neurological injuries associated with these events. This article describes our experience of managing paediatric neurosurgical blast injuries, from initial triage and operative management to longer-term considerations. MATERIALS AND METHODS Case study and literature review. RESULTS Paediatric traumatic and penetrating brain injury patients often make a good neurological recovery despite low GCS at time of injury; this should be accounted for during triage and operative decision making in major trauma, mass casualty events. Conservative management of retained shrapnel is advocated in view of low long-term infection rates with retained shrapnel and worsened neurological outcome with shrapnel retrieval. All penetrating brain injuries should receive a prolonged course of broad-spectrum antibiotics and undergo long term follow-up imaging to monitor for the development of cerebral abscesses. MRI should never be utilised in penetrating brain injury cases, even in the absence of macroscopically visible fragments, due to the effect of MRI ferromagnetic field torque on shrapnel fragments. Anti-epileptic drugs should only be prescribed for the initial seven days after injury, as continuing beyond this does not incur any benefit in the reduction of long term post-traumatic epilepsy. CONCLUSION All receiving neurosurgical units should become familiar with optimum management of these thankfully rare, but complex injuries from their initial presentation to long term follow up considerations. All neurosurgical units should have well-rehearsed local plans to follow in the event of such incidents, ensuring timely deliverance of appropriate neurosurgical care in such extreme settings.
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Affiliation(s)
- Catherine Pringle
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Matthew Bailey
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Shafqat Bukhari
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Ashraf El-Sayed
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Stephen Hughes
- Department of Microbiology and Immunology, Royal Manchester Children's Hospital, Manchester, UK
| | - Vivek Josan
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Roberto Ramirez
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Ian Kamaly-Asl
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
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Carnovale C, Pozzi M, Mazhar F, Mosini G, Gentili M, Peeters GGAM, Clementi E, Radice S. Interactions Between Antiepileptic and Antibiotic Drugs: A Systematic Review and Meta-Analysis with Dosing Implications. Clin Pharmacokinet 2018; 58:875-886. [DOI: 10.1007/s40262-018-0720-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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