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Mosini AC, Sanabria V, Nakamura TKE, Calió ML, Pompeu C, Silva CS, Nicolicht-Amorim P, da Graça Naffah-Mazzacoratti M, Porcionatto MA, Mello LE, Foresti ML. Posttraumatic epilepsy: Integrating clinical, inflammatory, and genetic profiles in traumatic brain injury patients. Epilepsy Res 2024; 205:107402. [PMID: 39024832 DOI: 10.1016/j.eplepsyres.2024.107402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/04/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE This study aims to assess the clinical, inflammatory, and genetic profiles of traumatic brain injury (TBI) patients over a 2-year follow-up period, focusing on the development of posttraumatic epilepsy (PTE). METHODS Fifty-nine patients with acute TBI were recruited in the emergency unit of a hospital in Brazil. Clinical data and blood samples were collected after 10 days of hospitalization for posterior genetic profile (Apolipoprotein E- ApoE and Glutamic Acid Descarboxylase-GAD sequencing) analyses. A subset of 19 patients were assessed for cytokine markers (mRNA expression). The development of PTE was investigated for two years following TBI. Statistical analyses including univariate analysis, multiple correspondence analysis, and Mann-Whitney test were performed. RESULTS Analysis revealed an association between severe TBI and requirement for neurosurgery and polytrauma (p<0.05), as well as the development of PTE over a two-year follow-up period (p<0.05). Multiple correspondence analysis identified two distinct profiles associated with PTE and Non-PTE outcomes. The PTE profile showed a higher prevalence of the ApoE genotype E3/E3 and GAD1 SNP (rs769391) genotype AA in our study, while the Non-PTE profile showed a higher presence of E3/E4. mRNA expression analysis demonstrated acute elevated levels of TNF-α in the PTE group as compared to Non-PTE patients (6.70±1.53 vs 5.31 ±0.33, p<0.01). SIGNIFICANCE Our findings underscore the multifactorial nature of aspects potentially contributing to PTE. It is unlikely that any single factor might in isolation have a strong causative influence over the development of epilepsy after TBI. Our results provide a suggestion of potential clustering that might be relevant as prognostic factors for PTE.
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Affiliation(s)
- Amanda C Mosini
- Laboratory of Neurobiology, Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil; Associação Brasileira de Epilepsia, São Paulo, Brazil; Associação Fundo de Incentivo à Pesquisa, AFIP, São Paulo, São Paulo, Brazil
| | - Viviam Sanabria
- Laboratory of Neurobiology, Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Michele L Calió
- Laboratory of Neurobiology, Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Clara Pompeu
- Laboratory of Neurobiology, Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Clivandir S Silva
- Laboratory of Neurobiology, Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Luiz Eugênio Mello
- Laboratory of Neurobiology, Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil; Instituto D'Or de Pesquisa e Ensino, São Paulo, São Paulo, Brazil.
| | - Maira L Foresti
- Laboratory of Neurobiology, Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil; Instituto D'Or de Pesquisa e Ensino, São Paulo, São Paulo, Brazil
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Atwood R, Walker P, Walper D, Bozzay J, Elster E, Bradley M. Risk Factors and Outcomes of Late Posttraumatic Seizures in Combat-Related Traumatic Brain Injury. J Surg Res 2024; 300:102-108. [PMID: 38805843 DOI: 10.1016/j.jss.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/26/2024] [Accepted: 04/18/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Post-traumatic seizures (PTSs) contribute to morbidity after traumatic brain injury (TBI). Early PTS are rare in combat casualties sustaining TBI, but the prevalence of late PTS is poorly described. We sought to define the prevalence and risk factors of late PTS in combat casualties with computed tomography evidence of TBI. METHODS From 2010 to 2015, 687 combat casualties were transferred to a military treatment facility and included in the Department of Defense Trauma Registry. 71 patients with radiographic evidence of TBI were analyzed. Data collection included demographics, injury characteristics, interventions, medications, and outcomes. RESULTS Of the 71 patients with evidence of TBI, 66 patients survived hospitalization and were followed. No patients had early PTS, and most received antiepileptic drugs (AEDs) for prophylaxis. At a median follow-up of 7.4 y, late PTS occurred in 25.8% of patients. Patients with late PTS were more severely injured (median Injury severity score 30 versus 24, P = 0.005) and required more blood products (18 units versus 2, P = 0.045). Patients with late PTS were more likely to have had a penetrating TBI (76.5% versus 38.8%, P = 0.01), multiple types of intracranial hemorrhage (94.1% versus 63.3%, P = 0.02), and cranial decompression (76.5% versus 28.6%, P = 0.001). Six-month Glasgow outcome scores were worse (3.5 versus 4.1 P = 0.001) in the late PTS population. No significant relationship was observed between administration of AEDs for early PTS prophylaxis and late PTS. CONCLUSIONS Combat casualties with TBI suffering late PTS are more severely injured and require more blood products. Penetrating TBI, intracranial hemorrhage, and need for cranial decompression are correlated with late PTS, and associated with worse Glasgow Outcome Score. The administration of prophylactic AEDs for early PTS was not associated with a difference in rates of late PTS.
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Affiliation(s)
- Rex Atwood
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
| | - Patrick Walker
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Daniel Walper
- Department of Psychiatry, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Joseph Bozzay
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Eric Elster
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Matthew Bradley
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Pyrzowski J, Kałas M, Mazurkiewicz-Bełdzińska M, Siemiński M. EEG biomarkers for the prediction of post-traumatic epilepsy - a systematic review of an emerging field. Seizure 2024; 119:71-77. [PMID: 38796954 DOI: 10.1016/j.seizure.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/24/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
Traumatic brain injury (TBI) is often followed by post-traumatic epilepsy (PTE), a condition often difficult to treat and leading to a substantial decline in quality of life as well as increased long-term mortality. The latent period between TBI and the emergence of spontaneous recurrent seizures provides an opportunity for pharmacological intervention to prevent epileptogenesis. Biomarkers capable of predicting PTE development are urgently needed to facilitate clinical trials of putative anti-epileptogenic drugs. EEG is a widely available and flexible diagnostic modality that plays a fundamental role in epileptology. We systematically review the advances in the field of the discovery of EEG biomarkers for the prediction of PTE in humans. Despite recent progress, the field faces several challenges including short observation periods, a focus on early post-injury monitoring, difficulties in translating findings from animal models to scalp EEG, and emerging evidence indicating the importance of assessing altered background scalp EEG activity alongside epileptiform activity using quantitative EEG methods while also considering sleep abnormalities in future studies.
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Affiliation(s)
- Jan Pyrzowski
- Department of Emergency Medicine, Medical University of Gdańsk, Gdańsk, Poland.
| | - Maria Kałas
- Department of Emergency Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Mariusz Siemiński
- Department of Emergency Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Ngadimon IW, Mohan D, Shaikh MF, Khoo CS, Tan HJ, Chamhuri NS, Cheong WL, Aledo-Serrano A, Yong LL, Lee YM, Fadzil F, Thanabalan J. Incidence and predictors of posttraumatic epilepsy and cognitive impairment in patients with traumatic brain injury: A retrospective cohort study in Malaysia. Epilepsia 2024; 65:1962-1974. [PMID: 38752783 DOI: 10.1111/epi.18007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE Posttraumatic epilepsy (PTE) significantly impacts morbidity and mortality, yet local PTE data remain scarce. In addition, there is a lack of evidence on cognitive comorbidity in individuals with PTE in the literature. We sought to identify potential PTE predictors and evaluate cognitive comorbidity in patients with PTE. METHODS A 2-year retrospective cohort study was employed, in which adults with a history of admission for traumatic brain injury (TBI) in 2019 and 2020 were contacted. Three hundred one individuals agreed to participate, with a median follow-up time of 30.75 months. The development of epilepsy was ascertained using a validated tool and confirmed by our neurologists during visits. Clinical psychologists assessed the patients' cognitive performance. RESULTS The 2-year cumulative incidence of PTE was 9.3% (95% confidence interval [CI] 5.9-12.7). The significant predictors of PTE were identified as a previous history of brain injury [hazard ratio [HR] 4.025, p = .021], and intraparenchymal hemorrhage (HR: 2.291, p = .036), after adjusting for other confounders. TBI patients with PTE performed significantly worse on the total ACE-III cognitive test (73.5 vs 87.0, p = .018), CTMT (27.5 vs 33.0, p = .044), and PSI (74.0 vs 86.0, p = .006) than TBI patients without PTE. A significantly higher percentage of individuals in the PTE group had cognitive impairment, compared to the non-PTE group based on ACE-III (53.6% vs 46.4%, p = .001) and PSI (70% vs 31.7%, p = .005) scores at 2 years post-TBI follow-up. SIGNIFICANCE This study emphasizes the link between TBI and PTE and the chance of developing cognitive impairment in the future. Clinicians can target interventions to prevent PTE by identifying specific predictors, which helps them make care decisions and develop therapies to improve patients' quality of life.
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Affiliation(s)
- Irma Wati Ngadimon
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- School of Dentistry and Medical Sciences, Charles Sturt University, Orange, New South Wales, Australia
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Ching Soong Khoo
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Neurology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Hui Jan Tan
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Neurology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Nor Syazwani Chamhuri
- Neurology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Wing Loong Cheong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Angel Aledo-Serrano
- Synaptia Epilepsy Center, Vithas La Milagrosa University Hospital, Madrid, Spain
| | - Li Ling Yong
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yu Mey Lee
- Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Farizal Fadzil
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Jegan Thanabalan
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Chen Y, Cappucci SP, Kim JA. Prognostic Implications of Early Prediction in Posttraumatic Epilepsy. Semin Neurol 2024; 44:333-341. [PMID: 38621706 DOI: 10.1055/s-0044-1785502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Posttraumatic epilepsy (PTE) is a complication of traumatic brain injury that can increase morbidity, but predicting which patients may develop PTE remains a challenge. Much work has been done to identify a variety of risk factors and biomarkers, or a combination thereof, for patients at highest risk of PTE. However, several issues have hampered progress toward fully adapted PTE models. Such issues include the need for models that are well-validated, cost-effective, and account for competing outcomes like death. Additionally, while an accurate PTE prediction model can provide quantitative prognostic information, how such information is communicated to inform shared decision-making and treatment strategies requires consideration of an individual patient's clinical trajectory and unique values, especially given the current absence of direct anti-epileptogenic treatments. Future work exploring approaches integrating individualized communication of prediction model results are needed.
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Affiliation(s)
- Yilun Chen
- Department of Neurology, Yale University, New Haven, Connecticut
| | | | - Jennifer A Kim
- Department of Neurology, Yale University, New Haven, Connecticut
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Pease M, Gupta K, Moshé SL, Correa DJ, Galanopoulou AS, Okonkwo DO, Gonzalez-Martinez J, Shutter L, Diaz-Arrastia R, Castellano JF. Insights into epileptogenesis from post-traumatic epilepsy. Nat Rev Neurol 2024; 20:298-312. [PMID: 38570704 DOI: 10.1038/s41582-024-00954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
Post-traumatic epilepsy (PTE) accounts for 5% of all epilepsies. The incidence of PTE after traumatic brain injury (TBI) depends on the severity of injury, approaching one in three in groups with the most severe injuries. The repeated seizures that characterize PTE impair neurological recovery and increase the risk of poor outcomes after TBI. Given this high risk of recurrent seizures and the relatively short latency period for their development after injury, PTE serves as a model disease to understand human epileptogenesis and trial novel anti-epileptogenic therapies. Epileptogenesis is the process whereby previously normal brain tissue becomes prone to recurrent abnormal electrical activity, ultimately resulting in seizures. In this Review, we describe the clinical course of PTE and highlight promising research into epileptogenesis and treatment using animal models of PTE. Clinical, imaging, EEG and fluid biomarkers are being developed to aid the identification of patients at high risk of PTE who might benefit from anti-epileptogenic therapies. Studies in preclinical models of PTE have identified tractable pathways and novel therapeutic strategies that can potentially prevent epilepsy, which remain to be validated in humans. In addition to improving outcomes after TBI, advances in PTE research are likely to provide therapeutic insights that are relevant to all epilepsies.
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Affiliation(s)
- Matthew Pease
- Department of Neurosurgery, Indiana University, Bloomington, IN, USA.
| | - Kunal Gupta
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Solomon L Moshé
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
- Department of Paediatrics, Albert Einstein College of Medicine, New York, NY, USA
| | - Daniel J Correa
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Aristea S Galanopoulou
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lori Shutter
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
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Yasuda S, Yano H, Ikegame Y, Kumagai M, Iwama T, Shinoda J, Izumo T. Posttraumatic epilepsy in chronic disorders of consciousness due to severe traumatic brain injury after traffic accidents. Seizure 2024; 117:222-228. [PMID: 38503099 DOI: 10.1016/j.seizure.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024] Open
Abstract
PURPOSE To evaluate the clinical state of posttraumatic epilepsy (PTE) in patients with chronic disorders of consciousness (CDC) due to severe traumatic brain injury (STBI) after traffic accidents and clarify the risk factors for seizure occurrence in such patients. METHODS Two hundred ninety-three patients with CDC due to STBI (mean age at admission [±standard deviation]: 36.4 ± 17.9 years; men: 71.7 %; mean duration of injury to admission: 416 ± 732 days; mean hospitalization time: 899 ± 319 days) were enrolled in this study. We retrospectively investigated the relationship between seizure conditions (type and frequency) and clinical data, including age, sex, pathological types of brain injury, with/without surgical intervention, degree of CDC, and administration of antiseizure medications (ASMs). RESULTS Overall, 52.9 % (n = 155/293) and 64.2 % of the patients (n = 183/of 285 patients surviving at discharge) were administered ASMs at admission and discharge, respectively. One hundred thirty-two patients (45.1 %) experienced epileptic seizures during hospitalization, and the mean seizure frequency was 4.0 ± 0.4 times per year. In multivariate analysis, significant and independent risk factors of seizure occurrence were revealed to be male sex, high National Agency for Automotive Safety and Victims' Aid score, hypoxic encephalopathy, and history of the neurosurgical operations. CONCLUSION The high prevalence of PTE in patients with CDC due to STBI, and the significant and independent risk factors for seizure occurrence in the chronic clinical phase were revealed. We expect that this study will aid toward improving clinical assessment and management of epileptic seizures in the population.
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Affiliation(s)
- Shoji Yasuda
- Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Minokamo 505-0034, Japan; Department of Neurosurgery, Chubu Neurorehabilitation Hospital, Minokamo 505-0034, Japan; Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.
| | - Hirohito Yano
- Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Minokamo 505-0034, Japan; Department of Neurosurgery, Chubu Neurorehabilitation Hospital, Minokamo 505-0034, Japan; Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Yuka Ikegame
- Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Minokamo 505-0034, Japan; Department of Neurosurgery, Chubu Neurorehabilitation Hospital, Minokamo 505-0034, Japan
| | - Morio Kumagai
- Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Minokamo 505-0034, Japan; Department of Neurosurgery, Chubu Neurorehabilitation Hospital, Minokamo 505-0034, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Jun Shinoda
- Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Minokamo 505-0034, Japan; Department of Neurosurgery, Chubu Neurorehabilitation Hospital, Minokamo 505-0034, Japan; Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
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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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Kazis D, Chatzikonstantinou S, Ciobica A, Kamal FZ, Burlui V, Calin G, Mavroudis I. Epidemiology, Risk Factors, and Biomarkers of Post-Traumatic Epilepsy: A Comprehensive Overview. Biomedicines 2024; 12:410. [PMID: 38398011 PMCID: PMC10886732 DOI: 10.3390/biomedicines12020410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
This paper presents an in-depth exploration of Post-Traumatic Epilepsy (PTE), a complex neurological disorder following traumatic brain injury (TBI), characterized by recurrent, unprovoked seizures. With TBI being a global health concern, understanding PTE is crucial for effective diagnosis, management, and prognosis. This study aims to provide a comprehensive overview of the epidemiology, risk factors, and emerging biomarkers of PTE, thereby informing clinical practice and guiding future research. The epidemiological aspect of the study reveals PTE as a significant contributor to acquired epilepsies, with varying incidence influenced by injury severity, age, and intracranial pathologies. The paper delves into the multifactorial nature of PTE risk factors, encompassing clinical, demographic, and genetic elements. Key insights include the association of injury severity, intracranial hemorrhages, and early seizures with increased PTE risk, and the roles of age, gender, and genetic predispositions. Advancements in neuroimaging, electroencephalography, and molecular biology are presented, highlighting their roles in identifying potential PTE biomarkers. These biomarkers, ranging from radiological signs to electroencephalography EEG patterns and molecular indicators, hold promise for enhancing PTE pathogenesis understanding, early diagnosis, and therapeutic guidance. The paper also discusses the critical roles of astrocytes and microglia in PTE, emphasizing the significance of neuroinflammation in PTE development. The insights from this review suggest potential therapeutic targets in neuroinflammation pathways. In conclusion, this paper synthesizes current knowledge in the field, emphasizing the need for continued research and a multidisciplinary approach to effectively manage PTE. Future research directions include longitudinal studies for a better understanding of TBI and PTE outcomes, and the development of targeted interventions based on individualized risk profiles. This research contributes significantly to the broader understanding of epilepsy and TBI.
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Affiliation(s)
- Dimitrios Kazis
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (D.K.)
| | - Symela Chatzikonstantinou
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (D.K.)
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, 20th Carol I Avenue, 700506 Iasi, Romania;
- Center of Biomedical Research, Romanian Academy, Iasi Branch, Teodor Codrescu 2, 700481 Iasi, Romania
- Academy of Romanian Scientists, 3 Ilfov, 050044 Bucharest, Romania
| | - Fatima Zahra Kamal
- Higher Institute of Nursing Professions and Health Technical (ISPITS), Marrakech 40000, Morocco
- Laboratory of Physical Chemistry of Processes and Materials, Faculty of Sciences and Techniques, Hassan First University, Settat 26000, Morocco
| | - Vasile Burlui
- Department of Biomaterials, Faculty of Dental Medicine, Apollonia University, 700511 Iasi, Romania;
| | - Gabriela Calin
- Department of Biomaterials, Faculty of Dental Medicine, Apollonia University, 700511 Iasi, Romania;
| | - Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, Leeds LS2 9JT, UK
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
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Sansone G, Megevand P, Vulliémoz S, Corbetta M, Picard F, Seeck M. Long-term outcome of alcohol withdrawal seizures. Eur J Neurol 2024; 31:e16075. [PMID: 37823698 PMCID: PMC11235997 DOI: 10.1111/ene.16075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/18/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE Alcohol withdrawal seizures (AWS) are a well-known complication of chronic alcohol abuse, but there is currently little knowledge of their long-term relapse rate and prognosis. The aims of this study were to identify risk factors for AWS recurrence and to study the overall outcome of patients after AWS. METHODS In this retrospective single-center study, we included patients who were admitted to the Emergency Department after an AWS between January 1, 2013 and August 10, 2021 and for whom an electroencephalogram (EEG) was requested. AWS relapses up until April 29, 2022 were researched. We compared history, treatment with benzodiazepines or antiseizure medications (ASMs), laboratory, EEG and computed tomography findings between patients with AWS relapse (r-AWS) and patients with no AWS relapse (nr-AWS). RESULTS A total of 199 patients were enrolled (mean age 53 ± 12 years; 78.9% men). AWS relapses occurred in 11% of patients, after a median time of 470.5 days. Brain computed tomography (n = 182) showed pathological findings in 35.7%. Risk factors for relapses were history of previous AWS (p = 0.013), skull fractures (p = 0.004) at the index AWS, and possibly epileptiform EEG abnormalities (p = 0.07). Benzodiazepines or other ASMs, taken before or after the index event, did not differ between the r-AWS and the nr-AWS group. The mortality rate was 2.9%/year of follow-up, which was 13 times higher compared to the general population. Risk factors for death were history of AWS (p < 0.001) and encephalopathic EEG (p = 0.043). CONCLUSIONS Delayed AWS relapses occur in 11% of patients and are associated with risk factors (previous AWS >24 h apart, skull fractures, and pathological EEG findings) that also increase the epilepsy risk, that is, predisposition for seizures, if not treated. Future prospective studies are mandatory to determine appropriate long-term diagnostic and therapeutic strategies, in order to reduce the risk of relapse and mortality associated with AWS.
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Affiliation(s)
- Giulio Sansone
- Department of Clinical NeurosciencesUniversity Hospital of Geneva & Faculty of MedicineGenevaSwitzerland
- Department of NeuroscienceUniversity of PadovaPadovaItaly
| | - Pierre Megevand
- Department of Clinical NeurosciencesUniversity Hospital of Geneva & Faculty of MedicineGenevaSwitzerland
| | - Serge Vulliémoz
- Department of Clinical NeurosciencesUniversity Hospital of Geneva & Faculty of MedicineGenevaSwitzerland
| | - Maurizio Corbetta
- Department of NeuroscienceUniversity of PadovaPadovaItaly
- Padova Neuroscience Center (PNC)University of PadovaPadovaItaly
- Venetian Institute of Molecular Medicine (VIMM)Fondazione BiomedicaPadovaItaly
| | - Fabienne Picard
- Department of Clinical NeurosciencesUniversity Hospital of Geneva & Faculty of MedicineGenevaSwitzerland
| | - Margitta Seeck
- Department of Clinical NeurosciencesUniversity Hospital of Geneva & Faculty of MedicineGenevaSwitzerland
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11
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Jacotte-Simancas A, Molina PE, Gilpin NW. Repeated Mild Traumatic Brain Injury and JZL184 Produce Sex-Specific Increases in Anxiety-Like Behavior and Alcohol Consumption in Wistar Rats. J Neurotrauma 2023; 40:2427-2441. [PMID: 37503666 PMCID: PMC10649186 DOI: 10.1089/neu.2023.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Alcohol use disorder (AUD) is highly comorbid with traumatic brain injury (TBI). Previously, using a lateral fluid percussion model (LFP) (an open-head injury model) to generate a single mild to moderate traumatic brain injury (TBI) we showed that TBI produces escalation in alcohol drinking, that alcohol exposure negatively impacts TBI outcomes, and that the endocannabinoid degradation inhibitor (JZL184) confers significant protection from behavioral and neuropathological outcomes in male rodents. In the present study, we used a weight drop model (a closed-head injury model) to produce repeated mild TBI (rmTBI; three TBIs separated by 24 hours) in male and female rats to examine the sex-specific effects on anxiety-like behavior and alcohol consumption, and whether systemic treatment with JZL184 would reverse TBI effects on those behaviors. In two separate studies, adult male and female Wistar rats were subjected to rmTBI or sham procedure using the weight drop model. Physiological measures of injury severity were collected from all animals. Animals in both studies were allowed to consume alcohol using an intermittent 2-bottle choice procedure (12 pre-TBI sessions and 12 post-TBI sessions). Neurological severity and neurobehavioral scores (NSS and NBS, respectively) were tested 24 hours after the final injury. Anxiety-like behavior was tested at 37-38 days post-injury in Study 1-, and 6-8-days post-injury in Study 2. Our results show that females exhibited reduced respiratory rates relative to males with no significant differences between Sham and rmTBI, no effect of rmTBI or sex on righting reflex, and increased neurological deficits in rmTBI groups in both studies. In Study 1, rmTBI increased alcohol consumption in female but not male rats. Male rats consistently exhibited higher levels of anxiety-like behavior than females. The rmTBI did not affect anxiety-like behavior 37-38 days post-injury. In Study 2, rmTBI once again increased alcohol consumption in female but not male rats, and repeated systemic treatment with JZL184 did not affect alcohol consumption. Also in Study 2, rmTBI increased anxiety-like behavior in males but not females and repeated systemic treatment with JZL184 produced an unexpected increase in anxiety-like behavior 6-8 days post-injury. In summary, rmTBI increased alcohol consumption in female rats, systemic JZL184 treatment did not alter alcohol consumption, and both rmTBI and systemic JZL184 treatment increased anxiety-like behavior 6-8 days post-injury in males but not females, highlighting robust sex differences in rmTBI effects.
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Affiliation(s)
- Alejandra Jacotte-Simancas
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol and Drug of Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Patricia E. Molina
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol and Drug of Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Nicholas W. Gilpin
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol and Drug of Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Southeast Louisiana VA Healthcare System, New Orleans, Louisiana, USA
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12
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Ulgen Tekerek N, Dursun O, Asilioglu Yener N, Yildizdas D, Anıl AB, Kendirli T, Koker A, Karalok S, Aksoy A, Kinik Kaya E, Ekinci F, Incecik F, Olgac Dundar N, Durak F, Botan E, Havan M, Sahin S, Duman O, Haspolat S. Posttraumatic epilepsy in critically ill children with traumatic brain injury. Childs Nerv Syst 2023; 39:3207-3214. [PMID: 37480521 DOI: 10.1007/s00381-023-06087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The aim of this study was to determine the clinical, laboratory, and radiological factors related with posttraumatic epilepsy (PTE). METHODS The study is a multicenter descriptive cross-sectional cohort study. Children who followed up for TBI in the pediatric intensive care unit between 2014 and 2021 were included. Demographic data and clinical and radiological parameters were recorded from electronic case forms. All patients who were in the 6-month posttraumatic period were evaluated by a neurologist for PTE. RESULTS Four hundred seventy-seven patients were included. The median age at the time of trauma was 66 (IQR 27-122) months, and 298 (62.5%) were male. Two hundred eighty (58.7%) patients had multiple traumas. The mortality rate was 11.7%. The mean duration of hospitalization, pediatric intensive care unit hospitalization and mechanical ventilation, Rotterdam score, PRISM III score, and GCS at admission were higher in patients with epilepsy (p < 0.05). The rate of epilepsy was higher in patients with severe TBI, cerebral edema on tomography and clinical findings of increased intracranial pressure, blood transfusion in the intensive care unit, multiple intracranial hemorrhages, and intubated patients (p < 0.05). In logistic regression analysis, the presence of intracranial hemorrhage in more than one compartment of the brain (OR 6.13, 95%CI 3.05-12.33) and the presence of seizures (OR 9.75, 95%CI 4.80-19.83) were independently significant in terms of the development of epilepsy (p < 0.001). CONCLUSIONS In this multicenter cross-sectional study, intracranial hemorrhages in more than one compartment and clinical seizures during intensive care unit admission were found to be independent risk factors for PTE development in pediatric intensive care unit patients with TBI.
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Affiliation(s)
- Nazan Ulgen Tekerek
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
- Akdeniz University Hospital, Dumlupınar Boulevard, Konyaalti, Antalya, 07059, Turkey.
| | - Oguz Dursun
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Nazik Asilioglu Yener
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Dincer Yildizdas
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ayşe Berna Anıl
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Katip Celebi University, İzmir, Turkey
| | - Tanil Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Alper Koker
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Selen Karalok
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ayşe Aksoy
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Elif Kinik Kaya
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Faruk Ekinci
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Faruk Incecik
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Nihal Olgac Dundar
- Division of Pediatric Neurology, Department of Pediatrics, Katip Celebi Faculty of Medicine, İzmir, Turkey
| | - Fatih Durak
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Katip Celebi University, İzmir, Turkey
| | - Edin Botan
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merve Havan
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Suleyman Sahin
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ozgur Duman
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Senay Haspolat
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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13
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Antaya TC, Le BN, Richard L, Qureshi A, Shariff SZ, Sposato LA, Burneo JG. Epilepsy Surgery in Adult Stroke Survivors with New-Onset Drug-Resistant Epilepsy. Can J Neurol Sci 2023; 50:673-678. [PMID: 36373342 DOI: 10.1017/cjn.2022.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite its effectiveness, surgery for drug-resistant epilepsy is underutilized. However, whether epilepsy surgery is also underutilized among patients with stroke-related drug-resistant epilepsy is unclear. Therefore, our objectives were to estimate the rates of epilepsy surgery assessment and receipt among patients with stroke-related drug-resistant epilepsy and to identify factors associated with these outcomes. METHODS We used linked health administrative databases to conduct a population-based retrospective cohort study of adult Ontario, Canada residents discharged from an Ontario acute care institution following the treatment of a stroke between January 1, 1997, and December 31, 2020, without prior evidence of seizures. We excluded patients who did not subsequently develop drug-resistant epilepsy and those with other epilepsy risk factors. We estimated the rates of epilepsy surgery assessment and receipt by March 31, 2021. We planned to use Fine-Gray subdistribution hazard models to identify covariates independently associated with our outcomes, controlling for the competing risk of death. RESULTS We identified 265,081 patients who survived until discharge following inpatient stroke treatment, 1,902 (0.7%) of whom subsequently developed drug-resistant epilepsy (805 women; mean age: 67.0 ± 13.1 years). Fewer than six (≤0.3%) of these patients were assessed for or received epilepsy surgery before the end of follow-up (≤55.5 per 100,000 person-years). Given that few outcomes were identified, we could not proceed with the multivariable analyses. CONCLUSIONS Patients with stroke-related drug-resistant epilepsy are infrequently considered for epilepsy surgery that could reduce morbidity and mortality.
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Affiliation(s)
- Tresah C Antaya
- Neuroepidemiology Research Unit, Department of Clinical Neurological Sciences, Western University, 1151 Richmond St, London, OntarioN6A 3K7, Canada
| | - Britney N Le
- ICES Western, 800 Commissioners Rd E, London, OntarioN6A 5W9, Canada
| | - Lucie Richard
- ICES Western, 800 Commissioners Rd E, London, OntarioN6A 5W9, Canada
| | - Amna Qureshi
- Neuroepidemiology Research Unit, Department of Clinical Neurological Sciences, Western University, 1151 Richmond St, London, OntarioN6A 3K7, Canada
| | - Salimah Z Shariff
- ICES Western, 800 Commissioners Rd E, London, OntarioN6A 5W9, Canada
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, Western University, 339 Windermere Rd, London, OntarioN6A 5A5, Canada
| | - Jorge G Burneo
- Neuroepidemiology Research Unit, Department of Clinical Neurological Sciences, Western University, 1151 Richmond St, London, OntarioN6A 3K7, Canada
- ICES Western, 800 Commissioners Rd E, London, OntarioN6A 5W9, Canada
- Epilepsy Program, Department of Clinical Neurological Sciences, Western University, 339 Windermere Rd, London, OntarioN6A 5A5, Canada
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14
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Semple BD, Panagiotopoulou O. Cranial Bone Changes Induced by Mild Traumatic Brain Injuries: A Neglected Player in Concussion Outcomes? Neurotrauma Rep 2023; 4:396-403. [PMID: 37350792 PMCID: PMC10282977 DOI: 10.1089/neur.2023.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Mild traumatic brain injuries (TBIs), particularly when repetitive in nature, are increasingly recognized to have a range of significant negative implications for brain health. Much of the ongoing research in the field is focused on the neurological consequences of these injuries and the relationship between TBIs and long-term neurodegenerative conditions such as chronic traumatic encephalopathy and Alzheimer's disease. However, our understanding of the complex relationship between applied mechanical force at impact, brain pathophysiology, and neurological function remains incomplete. Past research has shown that mild TBIs, even below the threshold that results in cranial fracture, induce changes in cranial bone structure and morphology. These structural and physiological changes likely have implications for the transmission of mechanical force into the underlying brain parenchyma. Here, we review this evidence in the context of the current understanding of bone mechanosensitivity and the consequences of TBIs or concussions. We postulate that heterogeneity of the calvarium, including differing bone thickness attributable to past impacts, age, or individual variability, may be a modulator of outcomes after subsequent TBIs. We advocate for greater consideration of cranial responses to TBI in both experimental and computer modeling of impact biomechanics, and raise the hypothesis that calvarial bone thickness represents a novel biomarker of brain injury vulnerability post-TBI.
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Affiliation(s)
- Bridgette D. Semple
- Department of Neuroscience, Monash University, Prahran, Victoria, Australia
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
| | - Olga Panagiotopoulou
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
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15
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Jacotte-Simancas A, Molina P, Gilpin N. JZL184 increases anxiety-like behavior and does not reduce alcohol consumption in female rats after repeated mild traumatic brain injury. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.30.542943. [PMID: 37398130 PMCID: PMC10312513 DOI: 10.1101/2023.05.30.542943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Alcohol use disorder (AUD) is highly comorbid with traumatic brain injury (TBI). Previously, using a lateral fluid percussion model (LFP) (an open model of head injury) to generate a single mild to moderate traumatic brain injury (TBI), we showed that TBI produces escalation in alcohol drinking, that alcohol exposure negatively impacts TBI outcomes, and that the endocannabinoid degradation inhibitor (JZL184) confers significant protection from behavioral and neuropathological outcomes in male rodents. In the present study, we used a weight drop model (a closed model of head injury) to produce a repeated mild TBI (rmTBI, 3 TBIs, spaced by 24 hours) to examine the sex-specific effects on alcohol consumption and anxiety-like behavior in rats, and whether systemic treatment with JZL184 would reverse TBI effects on those behaviors in both sexes. In two separate studies, adult male and female Wistar rats were subjected to rmTBI or sham using the weight drop model. Physiological measures of injury severity were collected from all animals. Animals in both studies were allowed to consume alcohol using an intermittent 2-bottle choice procedure (12 pre-TBI sessions and 12 post-TBI sessions). Neurological severity and neurobehavioral scores (NSS and NBS, respectively) were tested 24 hours after the final injury. Anxiety-like behavior was tested at 37-38 days post-injury in Study 1, and 6-8 days post-injury in Study 2. Our results show that females exhibited reduced respiratory rates relative to males with no significant differences between Sham and rmTBI, no effect of rmTBI or sex on righting reflex, and increased neurological deficits in rmTBI groups in both studies. In Study 1, rmTBI increased alcohol consumption in female but not male rats. Male rats consistently exhibited higher levels of anxiety-like behavior than females. rmTBI did not affect anxiety-like behavior 37-38 days post-injury. In Study 2, rmTBI once again increased alcohol consumption in female but not male rats, and repeated systemic treatment with JZL184 did not affect alcohol consumption. Also in Study 2, rmTBI increased anxiety-like behavior in males but not females and repeated systemic treatment with JZL184 produced an unexpected increase in anxiety-like behavior 6-8 days post-injury. In summary, rmTBI increased alcohol consumption in female rats, systemic JZL184 treatment did not alter alcohol consumption, and both rmTBI and sub-chronic systemic JZL184 treatment increased anxiety-like behavior 6-8 days post-injury in males but not females, highlighting robust sex differences in rmTBI effects.
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Affiliation(s)
- Alejandra Jacotte-Simancas
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA
- Alcohol and Drug of Abuse Center of Excellence, LSUHSC, New Orleans, LA
| | - Patricia Molina
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA
- Alcohol and Drug of Abuse Center of Excellence, LSUHSC, New Orleans, LA
| | - Nicholas Gilpin
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA
- Alcohol and Drug of Abuse Center of Excellence, LSUHSC, New Orleans, LA
- Southeast Louisiana VA Healthcare System, New Orleans, LA
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16
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Amin TA, Nerenberg SF, Elsawy OA, Wang A, Johnston JP. Evaluation of levetiracetam for early post-traumatic seizure prophylaxis: A level II trauma center experience. Surgeon 2023; 21:e78-e82. [PMID: 35660071 DOI: 10.1016/j.surge.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/07/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) can induce early or late post-traumatic seizures (PTS). While PTS incidence is low, prophylaxis is used despite a lack of consensus on agent or duration. Levetiracetam (LEV) for early PTS prophylaxis is preferred due to its safety and efficacy. The purpose of this study was to evaluate LEV for early PTS prophylaxis. METHODS AND MATERIALS A single-center, retrospective chart review of TBI patients ≥18 years who received LEV for early PTS prophylaxis between August 2018-July 2019. The primary outcome was LEV duration. Secondary outcomes were incidence of seizure, intensive care unit (ICU) and hospital length of stay (LOS). RESULTS Of the 137 included, mean age was 59 ± 20 years and 69.3% were male. The mean admission GCS was 13 ± 4 and 77.4% had mild TBI. Median LEV duration was 7 (IQR 4-10) days and 13.9% met recommended 7-day duration. Those prescribed LEV >7 days had more than twice the median LEV duration than those prescribed ≤7 days [10.25 (8.5-15.5) vs 4 (1.5-4.5) days, p < 0.0001]. Electroencephalography-confirmed PTS occurred in 2.2%, with an early PTS incidence of 0.73%. Median ICU and hospital LOS were 2 (IQR 1-7) and 7 (IQR 3-16) days, respectively. CONCLUSIONS The incidence of PTS was low as most patients in our study had mild or moderate TBI. Early PTS prophylaxis with LEV for 7 days is appropriate, although the majority of patients did not meet the recommended duration. Efforts to standardize and implement PTS prophylaxis protocols are needed.
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Affiliation(s)
- Timothy A Amin
- Department of Pharmacy, The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY, 11201, USA.
| | - Steven F Nerenberg
- Department of Pharmacy, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ, 07503, USA; Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
| | - Osama A Elsawy
- Department of Surgery - Trauma Division, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ, 07503, USA.
| | - Antai Wang
- Department of Mathematical Sciences, New Jersey Institute of Technology, 323 Dr Martin Luther King Jr Blvd, Newark, NJ, 07102, USA.
| | - Jackie P Johnston
- Department of Pharmacy, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ, 07503, USA; Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
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17
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Chen Y, Li S, Ge W, Jing J, Chen HY, Doherty D, Herman A, Kaleem S, Ding K, Osman G, Swisher CB, Smith C, Maciel CB, Alkhachroum A, Lee JW, Dhakar MB, Gilmore EJ, Sivaraju A, Hirsch LJ, Omay SB, Blumenfeld H, Sheth KN, Struck AF, Edlow BL, Westover MB, Kim JA. Quantitative epileptiform burden and electroencephalography background features predict post-traumatic epilepsy. J Neurol Neurosurg Psychiatry 2023; 94:245-249. [PMID: 36241423 PMCID: PMC9931627 DOI: 10.1136/jnnp-2022-329542] [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: 05/02/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Post-traumatic epilepsy (PTE) is a severe complication of traumatic brain injury (TBI). Electroencephalography aids early post-traumatic seizure diagnosis, but its optimal utility for PTE prediction remains unknown. We aim to evaluate the contribution of quantitative electroencephalograms to predict first-year PTE (PTE1). METHODS We performed a multicentre, retrospective case-control study of patients with TBI. 63 PTE1 patients were matched with 63 non-PTE1 patients by admission Glasgow Coma Scale score, age and sex. We evaluated the association of quantitative electroencephalography features with PTE1 using logistic regressions and examined their predictive value relative to TBI mechanism and CT abnormalities. RESULTS In the matched cohort (n=126), greater epileptiform burden, suppression burden and beta variability were associated with 4.6 times higher PTE1 risk based on multivariable logistic regression analysis (area under the receiver operating characteristic curve, AUC (95% CI) 0.69 (0.60 to 0.78)). Among 116 (92%) patients with available CT reports, adding quantitative electroencephalography features to a combined mechanism and CT model improved performance (AUC (95% CI), 0.71 (0.61 to 0.80) vs 0.61 (0.51 to 0.72)). CONCLUSIONS Epileptiform and spectral characteristics enhance covariates identified on TBI admission and CT abnormalities in PTE1 prediction. Future trials should incorporate quantitative electroencephalography features to validate this enhancement of PTE risk stratification models.
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Affiliation(s)
- Yilun Chen
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Songlu Li
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Wendong Ge
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jin Jing
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hsin Yi Chen
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Daniel Doherty
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alison Herman
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Safa Kaleem
- Neurology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kan Ding
- Neurology, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Christa B Swisher
- Neurology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christine Smith
- Neurology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Carolina B Maciel
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
- Neurology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ayham Alkhachroum
- Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
- Neurology, Jackson Memorial Hospital, Miami, Florida, USA
| | - Jong Woo Lee
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Monica B Dhakar
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emily J Gilmore
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | - Sacit B Omay
- Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hal Blumenfeld
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kevin N Sheth
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Aaron F Struck
- Neurology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
- Neurology, William S Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Brian L Edlow
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jennifer A Kim
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
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18
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Sivaraju A, Hirsch LJ. Do acute EEG findings add to clinical features in predicting outcomes after status epilepticus and acute symptomatic seizures? Epilepsy Behav 2023; 141:109134. [PMID: 36848748 DOI: 10.1016/j.yebeh.2023.109134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/02/2023] [Indexed: 02/27/2023]
Abstract
Status epilepticus is a potentially life-threatening medical emergency associated with poor functional outcomes. Improving our ability to accurately predict functional outcomes is beneficial to optimizing treatment strategies. Currently, there are four published status epilepticus scores in adults: STESS (Status Epilepticus Severity Score), EMSE (Epidemiology-Based Mortality Score in Status Epilepticus), END-IT (Encephalitis-Nonconvulsive-Diazepam resistance-Imaging-Tracheal intubation), and recently published ACD (Age-level of Consciousness-Duration of status epilepticus) score. The only available scale in the pediatric population is PEDSS (Pediatric CPC scale-EEG (normal vs abnormal)-Drug refractoriness-critical Sickness-Semiology). While these scores are useful research tools, currently there is little evidence to suggest their utility during real-time clinical care. Except for EMSE, none of the scores incorporate EEG findings for prognostication. Adding EEG features improves prognostic accuracy, as has been shown with the EMSE scale with and without the EEG component. Acute symptomatic seizures (AsyS) and early epileptiform abnormalities, especially nonconvulsive seizures, and periodic discharges, markedly increase the risk for subsequent unprovoked seizures. However, many of these patients may not need lifelong anti-seizure medications (ASMs). Continuous EEG monitoring shows that the majority of ASyS are nonconvulsive and can identify epileptic patterns. Dedicated specialty clinics for these patients, known as Post Acute Symptomatic Seizure (PASS) clinics, already exist in the United States. Post Acute Symptomatic Seizure clinics are ideal for both long-term clinical care and answering important research questions related to epileptogenesis, duration of ASM treatment required, and evolution of EEG findings. This topic was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Affiliation(s)
- Adithya Sivaraju
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, CT, United States.
| | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, CT, United States
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19
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Fitts MS, Cullen J, Kingston G, Johnson Y, Wills E, Soldatic K. Understanding the Lives of Aboriginal and Torres Strait Islander Women with Traumatic Brain Injury from Family Violence in Australia: A Qualitative Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1607. [PMID: 36674368 PMCID: PMC9861732 DOI: 10.3390/ijerph20021607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 06/16/2023]
Abstract
Globally, there is growing recognition of the connection between violence and head injuries. At present, little qualitative research exists around how surviving this experience impacts everyday life for women, particularly Aboriginal and Torres Strait Islander women. This project aims to explore the nature and context of these women's lives including living with the injury and to identify their needs and priorities during recovery. This 3-year exploratory project is being conducted across three Australian jurisdictions (Queensland, Northern Territory, and New South Wales). Qualitative interviews and discussion groups will be conducted with four key groups: Aboriginal and Torres Strait Islander women (aged 18+) who have acquired a head injury through family violence; their family members and/or carers; and hospital staff as well as government and non-government service providers who work with women who have experienced family violence. Nominated staff within community-based service providers will support the promotion of the project to women who have acquired a head injury through family violence. Hospital staff and service providers will be recruited using purposive and snowball sampling. Transcripts and fieldnotes will be analysed using narrative and descriptive phenomenological approaches. Reflection and research knowledge exchange and translation will be undertaken through service provider workshops.
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Affiliation(s)
- Michelle S. Fitts
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0871, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD 4878, Australia
| | - Jennifer Cullen
- Synapse Australia, Brisbane, QLD 3356, Australia
- College of Healthcare Sciences, James Cook University, Cairns, QLD 4878, Australia
| | - Gail Kingston
- Townsville Hospital and Health Service, Townsville, QLD 4814, Australia
| | - Yasmin Johnson
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
| | - Elaine Wills
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
| | - Karen Soldatic
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
- School of Social Sciences, Western Sydney University, Parramatta, NSW 2751, Australia
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20
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Motah M, Gams Massi D, Assonfack Sinju F, Magnerou AM, Bila Lamou EG, Nkouonlack C, Doumbe J, Esene I, Siysi VV, Eyenga VC, Mapoure YN. Post-traumatic epilepsy in Cameroon: a retrospective study in a referral hospital. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-022-00602-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Abstract
Background
Post-traumatic epilepsy is defined as the onset of at least one seizure beyond the first week following a traumatic brain injury (TBI). High prevalence of TBI in our setting may contribute to the burden of epilepsy in adult population. This is a retrospective review of medical records of patients admitted from January 1st, 2010 to December 31st, 2019) at Douala General Hospital. We included patients aged ≥ 18 years with seizure onset at least one week after TBI. Incomplete files and previously known epilepsy were excluded. Data on sociodemography, clinical and para-clinical features, treatment and outcome were analysed using R software version 36.2.
Results
We finally included 65 patients with post-traumatic epilepsy among 993 medical records of epilepsy. The mean age was 35.1 ± 12.6 years, with 64.6% of male. Road traffic accident was the main aetiology of brain trauma (78.5%), resulting in haemorrhagic contusions (21.5%), sub-dural haematoma (15.4%), and diffuse axonal lesions (15.4%) mainly. Seizure onset was within 2 years post-trauma in 73.8% of cases. Generalized tonic–clonic seizures were the commonest seizure’s type. Electroencephalogram was abnormal in 81%, including 47% of focal discharges. Antiepileptic drugs were mainly sodium valproate, carbamazepine, and phenobarbital. Seizure freedom was obtained in 67.7% of cases.
Conclusions
Post-traumatic epilepsy is a heterogeneous, frequent and often disabling complication of traumatic brain injury. Road traffic accident is the main cause of brain trauma. It affects a young and active population. About half of cases presented GTCS. With antiepileptic drugs, more than two-thirds of patients become seizure-free.
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21
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Aghdash SN, Foroughi G. Chemical Kindling as an Experimental Model to Assess the Conventional Drugs in the Treatment of Post-traumatic Epilepsy. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:1417-1428. [PMID: 36443981 DOI: 10.2174/1871527322666221128155813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality today, which will surpass many infectious diseases in the coming years/decades. Posttraumatic epilepsy (PTE) is one of the most common debilitating consequences of TBI. PTE is a secondary, acquired epilepsy that causes recurrent, spontaneous seizures more than a week after TBI. The extent of head injury in individuals who develop PTE is unknown; however, trauma is thought to account for 20% of symptomatic epilepsy worldwide. Understanding the mechanisms of epilepsy following TBI is crucial for the discovery of new anticonvulsant drugs for the treatment of PTE, as well as for improving the quality of life of patients with PTE. OBJECTIVE This review article explains the rationale for the usage of a chemical model to access new treatments for post-traumatic epilepsy. RESULTS There are multiple methods to control and manage PTE. The essential and available remedy for the management of epilepsy is the use of antiepileptic drugs. Antiepileptic drugs (AEDs) decrease the frequency of seizures without affecting the disease's causality. Antiepileptic drugs are administrated for the prevention and treatment of PTE; however, 30% of epilepsy patients are drug-resistant, and AED side effects are significant in PTE patients. There are different types of animal models, such as the liquid percussion model, intracortical ferric chloride injection, and cortical subincision model, to study PTE and neurophysiological mechanisms underlying the development of epilepsy after head injury. However, these animal models do not easily mimic the pathological events occurring in epilepsy. Therefore, animal models of PTE are an inappropriate tool for screening new and putatively effective AEDs. Chemical kindling is the most common animal model used to study epilepsy. There is a strong similarity between the kindling model and different types of human epilepsy. CONCLUSION Today, researchers use experimental animal models to evaluate new anticonvulsant drugs. The chemical kindling models, such as pentylenetetrazol, bicuculline, and picrotoxin-induced seizures, are important experimental models to analyze the impact of putative antiepileptic drugs.
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Affiliation(s)
- Simin Namvar Aghdash
- Department of Biology, Faculty of Basic Sciences, Azarbaijan Shahid Madani University, Tabriz, Iran
| | - Golsa Foroughi
- Department of Biology, Faculty of Basic Sciences, Azarbaijan Shahid Madani University, Tabriz, Iran
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22
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Establishment and validation of PTE prediction model in patients with cerebral contusion. Sci Rep 2022; 12:20574. [PMID: 36446999 PMCID: PMC9708650 DOI: 10.1038/s41598-022-24824-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022] Open
Abstract
Post-traumatic epilepsy (PTE) is an important cause of poor prognosis in patients with cerebral contusions. The primary purpose of this study is to evaluate the high-risk factors of PTE by summarizing and analyzing the baseline data, laboratory examination, and imaging features of patients with a cerebral contusion, and then developing a Nomogram prediction model and validating it. This study included 457 patients diagnosed with cerebral contusion who met the inclusion criteria from November 2016 to November 2019 at the Qinghai Provincial People's Hospital. All patients were assessed for seizure activity seven days after injury. Univariate analysis was used to determine the risk factors for PTE. Significant risk factors in univariate analysis were selected for binary logistic regression analysis. P < 0.05 was statistically significant. Based on the binary logistic regression analysis results, the prediction scoring system of PTE is established by Nomogram, and the line chart model is drawn. Finally, external validation was performed on 457 participants to assess its performance. Univariate and binary logistic regression analyses were performed using SPSS software, and the independent predictors significantly associated with PTE were screened as Contusion site, Chronic alcohol use, Contusion volume, Skull fracture, Subdural hematoma (SDH), Glasgow coma scale (GCS) score, and Non late post-traumatic seizure (Non-LPTS). Based on this, a Nomogram model was developed. The prediction accuracy of our scoring system was C-index = 98.29%. The confidence interval of the C-index was 97.28% ~ 99.30%. Internal validation showed that the calibration plot of this model was close to the ideal line. This study developed and verified a highly accurate Nomogram model, which can be used to individualize PTE prediction in patients with a cerebral contusion. It can identify individuals at high risk of PTE and help us pay attention to prevention in advance. The model has a low cost and is easy to be popularized in the clinic. This model still has some limitations and deficiencies, which need to be verified and improved by future large-sample and multicenter prospective studies.
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23
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Zhao G, Fu Y, Yang C, Yang X, Hu X. Exploring the pathogenesis linking traumatic brain injury and epilepsy via bioinformatic analyses. Front Aging Neurosci 2022; 14:1047908. [PMID: 36438009 PMCID: PMC9686289 DOI: 10.3389/fnagi.2022.1047908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/28/2022] [Indexed: 07/25/2024] Open
Abstract
Traumatic brain injury (TBI) is a serious disease that could increase the risk of epilepsy. The purpose of this article is to explore the common molecular mechanism in TBI and epilepsy with the aim of providing a theoretical basis for the prevention and treatment of post-traumatic epilepsy (PTE). Two datasets of TBI and epilepsy in the Gene Expression Omnibus (GEO) database were downloaded. Functional enrichment analysis, protein-protein interaction (PPI) network construction, and hub gene identification were performed based on the cross-talk genes of aforementioned two diseases. Another dataset was used to validate these hub genes. Moreover, the abundance of infiltrating immune cells was evaluated through Immune Cell Abundance Identifier (ImmuCellAI). The common microRNAs (miRNAs) between TBI and epilepsy were acquired via the Human microRNA Disease Database (HMDD). The overlapped genes in cross-talk genes and target genes predicted through the TargetScan were obtained to construct the common miRNAs-mRNAs network. A total of 106 cross-talk genes were screened out, including 37 upregulated and 69 downregulated genes. Through the enrichment analyses, we showed that the terms about cytokine and immunity were enriched many times, particularly interferon gamma signaling pathway. Four critical hub genes were screened out for co-expression analysis. The miRNA-mRNA network revealed that three miRNAs may affect the shared interferon-induced genes, which might have essential roles in PTE. Our study showed the potential role of interferon gamma signaling pathway in pathogenesis of PTE, which may provide a promising target for future therapeutic interventions.
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Affiliation(s)
- Gengshui Zhao
- Department of Neurosurgery, The People’s Hospital of Hengshui City, Hengshui, China
| | - Yongqi Fu
- Department of Endocrinology, The People’s Hospital of Hengshui City, Hengshui, China
| | - Chao Yang
- Department of Orthopedics, The People’s Hospital of Hengshui City, Hengshui, China
| | - Xuehui Yang
- Department of Neurosurgery, The People’s Hospital of Hengshui City, Hengshui, China
| | - Xiaoxiao Hu
- Department of Neurosurgery, The People’s Hospital of Hengshui City, Hengshui, China
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24
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Mariajoseph FP, Chen Z, Sekhar P, Rewell SS, O'Brien TJ, Antonic‐Baker A, Semple BD. Incidence and risk factors of posttraumatic epilepsy following pediatric traumatic brain injury: A systematic review and meta-analysis. Epilepsia 2022; 63:2802-2812. [PMID: 35996866 PMCID: PMC9826023 DOI: 10.1111/epi.17398] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/31/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
Posttraumatic epilepsy (PTE) is a well-known chronic complication following traumatic brain injury (TBI). Despite some evidence that age at the time of injury may influence the likelihood of PTE, the incidence of PTE in pediatric populations remains unclear. We therefore conducted a systematic review to determine the overall reported incidence of PTE, and explore potential risk factors associated with PTE after pediatric TBI. A comprehensive literature search of the PubMed, Embase, and Web of Science databases was conducted, including randomized controlled trials and cohort studies assessing the incidence of PTE in TBI pediatric patients. We excluded studies with a sample size of <10 patients and those in which a pediatric cohort was not clearly discernable. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We found that the overall incidence of PTE following pediatric TBI was 10% (95% confidence interval [CI] = 5.9%-15%). Subgroup analysis of a small number of studies demonstrated that the occurrence of early seizures (cumulative incidence ratio [CIR] = 7.28, 95% CI = 1.09-48.4, p = .040), severe TBI (CIR = 1.81, 95% CI = 1.23-2.67, p < .001), and intracranial hemorrhage (CIR = 1.60, 95% CI = 1.06-2.40, p = .024) increased the risk of PTE in this population. Other factors, including male sex and neurosurgical intervention, were nonsignificantly associated with a higher incidence of PTE. In conclusion, PTE is a significant chronic complication following childhood TBI, similar to in the adult population. Further standardized investigation into clinical risk factors and management guidelines is warranted. PROSPERO ID# CRD42021245802.
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Affiliation(s)
| | - Zhibin Chen
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Praba Sekhar
- School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Sarah S. Rewell
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia,Department of NeurologyAlfred HealthPrahranVictoriaAustralia
| | - Terence J. O'Brien
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia,Department of NeurologyAlfred HealthPrahranVictoriaAustralia,Department of Medicine (Royal Melbourne Hospital)University of MelbourneParkvilleVictoriaAustralia
| | - Ana Antonic‐Baker
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Bridgette D. Semple
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia,Department of NeurologyAlfred HealthPrahranVictoriaAustralia,Department of Medicine (Royal Melbourne Hospital)University of MelbourneParkvilleVictoriaAustralia
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25
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Manninen E, Chary K, De Feo R, Hämäläinen E, Andrade P, Paananen T, Sierra A, Tohka J, Gröhn O, Pitkänen A. Acute Hippocampal Damage as a Prognostic Biomarker for Cognitive Decline but Not for Epileptogenesis after Experimental Traumatic Brain Injury. Biomedicines 2022; 10:2721. [PMID: 36359242 PMCID: PMC9687561 DOI: 10.3390/biomedicines10112721] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/02/2023] Open
Abstract
It is necessary to develop reliable biomarkers for epileptogenesis and cognitive impairment after traumatic brain injury when searching for novel antiepileptogenic and cognition-enhancing treatments. We hypothesized that a multiparametric magnetic resonance imaging (MRI) analysis along the septotemporal hippocampal axis could predict the development of post-traumatic epilepsy and cognitive impairment. We performed quantitative T2 and T2* MRIs at 2, 7 and 21 days, and diffusion tensor imaging at 7 and 21 days after lateral fluid-percussion injury in male rats. Morris water maze tests conducted between 35-39 days post-injury were used to diagnose cognitive impairment. One-month-long continuous video-electroencephalography monitoring during the 6th post-injury month was used to diagnose epilepsy. Single-parameter and regularized multiple linear regression models were able to differentiate between sham-operated and brain-injured rats. In the ipsilateral hippocampus, differentiation between the groups was achieved at most septotemporal locations (cross-validated area under the receiver operating characteristic curve (AUC) 1.0, 95% confidence interval 1.0-1.0). In the contralateral hippocampus, the highest differentiation was evident in the septal pole (AUC 0.92, 95% confidence interval 0.82-0.97). Logistic regression analysis of parameters imaged at 3.4 mm from the contralateral hippocampus's temporal end differentiated between the cognitively impaired rats and normal rats (AUC 0.72, 95% confidence interval 0.55-0.84). Neither single nor multiparametric approaches could identify the rats that would develop post-traumatic epilepsy. Multiparametric MRI analysis of the hippocampus can be used to identify cognitive impairment after an experimental traumatic brain injury. This information can be used to select subjects for preclinical trials of cognition-improving interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Asla Pitkänen
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
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26
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Hophing L, Kyriakopoulos P, Bui E. Sex and gender differences in epilepsy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:235-276. [PMID: 36038205 DOI: 10.1016/bs.irn.2022.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sex and gender differences in epilepsy are important influencing factors in epilepsy care. In epilepsy, the hormonal differences between the sexes are important as they impact specific treatment considerations for patients at various life stages particularly during early adulthood with establishment of the menstrual cycle, pregnancy, perimenopause and menopause. Choice of antiseizure medication may have direct consequences on hormonal cycles, hormonal contraception, pregnancy and fetal risk of major congenital malformation. Conversely hormones whether intrinsic or extrinsically administered may have direct impact on antiseizure medications and seizure control. This chapter explores these important influences on the management of persons with epilepsy.
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Affiliation(s)
- Lauren Hophing
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada
| | | | - Esther Bui
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada.
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27
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Bakhtiar Y, Khairunnisa NI, Prihastomo KT, Brotoarianto HK, Arifin MT, Muttaqin Z. Posttraumatic epilepsy: A single institution case series in Indonesia. Surg Neurol Int 2022; 13:298. [PMID: 35928318 PMCID: PMC9345106 DOI: 10.25259/sni_142_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/20/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Posttraumatic epilepsy (PTE) is a debilitating sequelae following traumatic brain injury (TBI). Risk of developing PTE is higher in the first 6 months following head trauma and remains increased for 10 years. Many cases of PTE developed into drug-resistant epilepsy in which need surgical treatment.
Case Description:
Fourteen patients were identified from 1998 until 2021. Mean age at onset was 21.00 ± 6.13 years, mean age of surgery was 29.50 ± 6.83 years. All patients had partial complex seizure with more than half of cases (n = 10, 71.4%) reported with focal impaired awareness seizure and focal to bilateral tonic–clonic type of seizure which were observed in the remained cases (n = 4, 28.6%). Abnormal magnetic resonance imaging findings were observed in 12 patients: mesial temporal sclerosis (n = 7), encephalomalacia (n = 4), brain atrophy (n = 4), and focal cortical dysplasia (n = 2). More than half of cases presented with mesial temporal lobe epilepsy despite site and type of brain injury. Most patients who undergone epileptogenic focus resection were free of seizure, but two patients remained to have seizure with worthwhile improvement.
Conclusion:
This study emphasizes the clinical characteristic of PTE cases in our center in Indonesia. While encephalomalacia is a typical finding following TBI and often responsible for epilepsy, electroencephalogram recording remains critical in determining epileptic focus. Most of PTE patients presented with temporal lobe epilepsy had excellent outcomes after surgical resection of epileptogenic focus.
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Affiliation(s)
- Yuriz Bakhtiar
- Department of Neurosurgery, Diponegoro University, Semarang, Central Java, Indonesia
| | | | | | - Happy Kurnia Brotoarianto
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia
| | - Muhamad Thohar Arifin
- Department of Neurosurgery, Diponegoro University, Semarang, Central Java, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Diponegoro University, Semarang, Central Java, Indonesia
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28
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Yu T, Liu X, Sun L, Lv R, Wu J, Wang Q. Risk factors for Drug-resistant Epilepsy (DRE) and a nomogram model to predict DRE development in post-traumatic epilepsy patients. CNS Neurosci Ther 2022; 28:1557-1567. [PMID: 35822252 PMCID: PMC9437227 DOI: 10.1111/cns.13897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/22/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives To identify factors affecting the development of drug‐resistant epilepsy (DRE), and establish a reliable nomogram to predict DRE development in post‐traumatic epilepsy (PTE) patients. Methods This study conducted a retrospective clinical analysis in patients with PTE who visited the Epilepsy Center, Beijing Tiantan Hospital from January 2013 to December 2018. All participants were followed up for at least 3 years, and the development of DRE was assessed. Data from January 2013 to December 2017 were used as development dataset for model building. Those independent predictors of DRE were included in the final multivariable logistic regression, and a derived nomogram was built. Data from January 2018 to December 2018 were used as validation dataset for internal validation. Results Complete clinical information was available for 2830 PTE patients (development dataset: 2023; validation dataset: 807), of which 21.06% (n = 596) developed DRE. Among all parameters of interest including gender, age at PTE, family history, severity of traumatic brain injury (TBI), single or multiple injuries, lesion location, post‐TBI treatments, acute seizures, PTE latency, seizure type, status epilepticus (SE), and electroencephalogram (EEG) findings, four predictors showed independent effect on DRE, they were age at PTE, seizure type, SE, and EEG findings. A model incorporating these four variables was created, and a nomogram to calculate the probability of DRE using the coefficients of the model was developed. The C‐index of the predictive model and the validation was 0.662 and 0.690, respectively. The goodness‐of‐fit test indicated good calibration for model development and validation (p = 0.272, 0.572). Conclusions The proposed nomogram achieved significant potential for clinical utility in the prediction of DRE among PTE patients. The risk of DRE for individual PTE patients can be estimated by using this nomogram, and identified high‐risk patients might benefit from non‐pharmacological therapies at an early stage.
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Affiliation(s)
- Tingting Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiao Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lei Sun
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ruijuan Lv
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianping Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
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29
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van Vliet EA, Marchi N. Neurovascular unit dysfunction as a mechanism of seizures and epilepsy during aging. Epilepsia 2022; 63:1297-1313. [PMID: 35218208 PMCID: PMC9321014 DOI: 10.1111/epi.17210] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
The term neurovascular unit (NVU) describes the structural and functional liaison between specialized brain endothelium, glial and mural cells, and neurons. Within the NVU, the blood‐brain barrier (BBB) is the microvascular structure regulating neuronal physiology and immune cross‐talk, and its properties adapt to brain aging. Here, we analyze a research framework where NVU dysfunction, caused by acute insults or disease progression in the aging brain, represents a converging mechanism underlying late‐onset seizures or epilepsy and neurological or neurodegenerative sequelae. Furthermore, seizure activity may accelerate brain aging by sustaining regional NVU dysfunction, and a cerebrovascular pathology may link seizures to comorbidities. Next, we focus on NVU diagnostic approaches that could be tailored to seizure conditions in the elderly. We also examine the impending disease‐modifying strategies based on the restoration of the NVU and, more in general, the homeostatic control of anti‐ and pro‐inflammatory players. We conclude with an outlook on current pre‐clinical knowledge gaps and clinical challenges pertinent to seizure onset and conditions in an aging population.
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Affiliation(s)
- Erwin A van Vliet
- Amsterdam UMC, University of Amsterdam, dept. of (Neuro)pathology, Amsterdam, the Netherlands.,University of Amsterdam, Swammerdam Institute for Life Sciences, Center for Neuroscience, Amsterdam, the Netherlands
| | - Nicola Marchi
- Cerebrovascular and Glia Research, Department of Neuroscience, Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
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Ngadimon IW, Aledo-Serrano A, Arulsamy A, Mohan D, Khoo CS, Cheong WL, Shaikh MF. An Interplay Between Post-Traumatic Epilepsy and Associated Cognitive Decline: A Systematic Review. Front Neurol 2022; 13:827571. [PMID: 35280285 PMCID: PMC8908100 DOI: 10.3389/fneur.2022.827571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/26/2022] [Indexed: 01/08/2023] Open
Abstract
BackgroundPost-traumatic epilepsy (PTE) is a devastating neurological outcome of traumatic brain injury (TBI), which may negatively impact the quality of life of patients with TBI, and may impose a huge socioeconomic burden. This burden may be due to long-term functional outcomes associated with PTE, particularly cognitive dysfunction. To date, the relationship between TBI and PTE remains unclear, with little known about how the effect of their link on cognitive function as well.ObjectiveThus, this systematic review aimed at elucidating the relationship between PTE and cognitive impairment in adults after TBI based on available clinical studies, in hopes to aid in the development of therapeutic strategies for PTE.MethodsA systematic literature search was performed using 6 databases; MEDLINE, Embase, CINAHL, Psych INFO, Web of Science, and Cochrane to retrieve relevant clinical studies investigating the link between PTE and cognition in the context of TBI. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of relevant studies.ResultsA total of six eligible studies were included for critical appraisal in this review after performing the inclusion and exclusion criteria, which involved 1,100 individuals, from 1996 to 2021. The selected studies were derived from the civilian and military population, with a follow-up period that ranged from 6 months to 35 years. The average quality of the involved studies was moderate (6.6, SD = 1.89). Five out of six studies found poorer cognitive performance in people with PTE, compared with those without PTE. Although the association between PTE and cognitive impairment was insignificant after controlling for specific covariates, there was a statistical trend toward significance.ConclusionThis systematic review suggests that there may be a possible link between PTE and cognitive decline in TBI patients, with the latter being reported to occur up to 35 years post injury. Variations in sample sizes, follow-up periods, and neuropsychological assessment tools may be the limitations affecting the interpretation and significance of this relationship. Therefore, future studies with standard cognitive assessment tools may be warranted to solidify the link between TBI-PTE-cognitive dysfunction, prior to the development of therapeutic strategies.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020221702, prospero identifier: CRD42020221702.
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Affiliation(s)
- Irma Wati Ngadimon
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Angel Aledo-Serrano
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain
| | - Alina Arulsamy
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Ching Soong Khoo
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Wing Loong Cheong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | - Mohd. Farooq Shaikh
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
- *Correspondence: Mohd. Farooq Shaikh
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Chen KN, Guan QW, Yin XX, Wang ZJ, Zhou HH, Mao XY. Ferrostatin-1 obviates seizures and associated cognitive deficits in ferric chloride-induced posttraumatic epilepsy via suppressing ferroptosis. Free Radic Biol Med 2022; 179:109-118. [PMID: 34952157 DOI: 10.1016/j.freeradbiomed.2021.12.268] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/28/2021] [Accepted: 12/16/2021] [Indexed: 12/16/2022]
Abstract
Posttraumatic epilepsy (PTE) is a prevalent complication of brain trauma. Current anti-epileptic drugs available do not have satisfactory response to PTE. It is of desperate need to explore novel therapeutic approaches for curing PTE. Our prior work revealed that ferroptosis, a recently discovered mode of cell death, occurs in rodent model of PTE. In the present study, we aimed to further investigate the effect of ferrostatin-1 (Fer-1), a specific ferroptosis inhibitor, on seizure behavior and cognitive deficit in a mouse model of PTE. The preparation of PTE was performed by stereotaxical injection in the somatosensory cortex region of 50 mM FeCl3. Seizure activity was assessed via Racine scoring and electroencephalogram analysis. PTE-related cognitive function was evaluated by novel object recognition and Morris water maze tests. Ferroptosis-related indices including glutathione peroxidase (GPx) activity and protein expressions of 4-hydroxynonenal (4-HNE) were detected using a commercial kit and immunofluorescence, respectively. It was found that treatment with Fer-1 significantly exerted protective effects against acute seizure and memory decline, although no evident effect on epileptic progression. Fer-1 also exhibited good tolerability and safety as we observed that it hardly influenced the body weight. Furthermore, it was noted that administration of Fer-1 suppressed ferroptosis-related indices including GPx activity and protein expressions of 4-HNE in hippocampus. These data altogether indicate that Fer-1 has potent therapeutic effects against seizures and cognitive impairment following PTE-induced brain insult. Fer-1 may act as a promising drug for curing PTE patients.
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Affiliation(s)
- Kang-Ni Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, PR China; Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, PR China; National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha, 410008, Hunan, PR China
| | - Qi-Wen Guan
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, PR China; Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, PR China; National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha, 410008, Hunan, PR China
| | - Xi-Xi Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Zhao-Jun Wang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, PR China; Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, PR China; National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha, 410008, Hunan, PR China
| | - Hong-Hao Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, PR China; Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, PR China; National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha, 410008, Hunan, PR China
| | - Xiao-Yuan Mao
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, PR China; Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, PR China; National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha, 410008, Hunan, PR China.
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Omalu B, Hammers J. In Reply: Recommendation to Create New Neuropathologic Guidelines for the Postmortem Diagnosis of Chronic Traumatic Encephalopathy. Neurosurgery 2022; 90:e21-e23. [PMID: 34982893 DOI: 10.1227/neu.0000000000001768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bennet Omalu
- Department of Medical Pathology and Laboratory Medicine , University of California, Davis, Davis , California , USA
| | - Jennifer Hammers
- Forensic Science and Law Program , Bayer School of Natural and Environmental Sciences , Duquesne University, Pittsburgh , Pennsylvania , USA
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Outcomes of patients with nonepileptic transient neurologic symptoms after subdural hematoma evacuation. Acta Neurochir (Wien) 2021; 163:3267-3277. [PMID: 34668079 DOI: 10.1007/s00701-021-05030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients undergoing a subdural hematoma (SDH) evacuation can experience transient neurological symptoms (TNS) postoperatively. Electroencephalography (EEG) is used to rule out seizures. We aim to characterize patients with TNS and negative epileptiform activity on EEG and compare them to those with positive epileptiform EEG findings. METHODS We performed a retrospective study of adult patients who underwent EEG for evaluation of TNS after undergoing SDH evacuation. Patients were stratified based on SDH type (acute and non-acute) and whether or not their EEG demonstrated positive epileptiform activity. A multivariate analysis was performed to identify predictors of negative EEG findings. RESULTS One hundred twenty-nine SDH patients were included (45 (34.9%) acute; 84 (65.1%) non-acute). Overall, 45 (24 acute and 21 non-acute SDH patients) had positive epileptiform EEG findings, and 84 (21 acute and 63 non-acute SDH patients) had a negative EEG. Acute and non-acute SDH patients with positive EEG findings were more likely to suffer from greater than five episodes of TNS, impaired awareness, and motor symptoms, while the negative EEG group was more likely to suffer from negative symptoms. Non-acute SDH patients with positive EEG had longer mean ICU stays (14.6 vs. 7.2; p = 0.005). Both acute and non-acute SDH-positive EEG patients had worse disposition upon discharge (p < 0.05), worse modified Rankin score at discharge (p < 0.05), and 3-month follow-up (p < 0.05) and were more likely to be discharged on more than one antiepileptic drug (p < 0.001). CONCLUSION Postoperative acute and non-acute SDH patients with TNS and negative EEG results are likely to have a favorable clinical picture. This distinction is therapeutically and prognostically important as these patients may not respond to typical antiepileptic drugs and they have better functional outcomes.
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Zhan J, Ma Y, Zhao D, Li Z, Tan H, Wang X, Liu H, Yang T. Knowledge atlas of post-traumatic epilepsy research: Based on citespace visualization analysis. Epilepsy Res 2021; 178:106790. [PMID: 34798493 DOI: 10.1016/j.eplepsyres.2021.106790] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/15/2021] [Accepted: 10/15/2021] [Indexed: 01/23/2023]
Abstract
The mechanism of posttraumatic epilepsy (PTE) is complicated and the treatment and prognostic effects are not satisfactory. In this study, CiteSpace and VOSviewer are used to analyze the literature related to PTE (January 2000-June 2020). The aspects of the cooperative network (author, institution, and country), keywords co-occurrence, document co-citation clustering, and journal dual-map overlay were analyzed, and the atlas was constructed. The United States, Finland, and other research institutions have frequently published PTE-related articles, thus having richer research results. The relevant research was mostly published in journals, such as Journal of Neurotrauma, Journal of Neuroscience, Brain Research, Neurobiology of Disease. Quantitative diffusion MRI plays a critical role in PTE research. The study on the susceptibility to seizures and the underlying mechanism of PTE received different degrees of attention. The present study provided an in-depth understanding of the research foundation, relevant research results, the current research frontiers, and the main research focus in the PTE field. Herein, we briefly discussed relevant key articles and also provided ideas for future research directions.
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Affiliation(s)
- Jingjing Zhan
- Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing, China; Collaborative Innovation Center of Judicial Civilization, Beijing, China
| | - Yixun Ma
- Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing, China; Collaborative Innovation Center of Judicial Civilization, Beijing, China
| | - Dong Zhao
- Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing, China; Collaborative Innovation Center of Judicial Civilization, Beijing, China
| | - Zheng Li
- Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing, China; Collaborative Innovation Center of Judicial Civilization, Beijing, China
| | - Huachao Tan
- Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing, China; Collaborative Innovation Center of Judicial Civilization, Beijing, China
| | - Xu Wang
- Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing, China; Collaborative Innovation Center of Judicial Civilization, Beijing, China
| | - Hongxia Liu
- China University of Political Science and Law, The Institute for Digital Technology and Law (IDTL), China; The CUPL Scientometrics and Evaluation Center of Rule of Law, China.
| | - Tiantong Yang
- Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing, China; Collaborative Innovation Center of Judicial Civilization, Beijing, China.
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Mariajoseph FP, Rewell SS, O'Brien TJ, Semple BD, Antonic-Baker A. Incidence of post-traumatic epilepsy following paediatric traumatic brain injury: protocol for systematic review and meta-analysis. BMJ Open 2021; 11:e054034. [PMID: 34728458 PMCID: PMC8565535 DOI: 10.1136/bmjopen-2021-054034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Post-traumatic epilepsy (PTE) is a recognised complication of traumatic brain injury (TBI), and is associated with higher rates of mortality and morbidity when compared with patients with TBI who do not develop PTE. The majority of the literature on PTE has focused on adult populations, and consequently there is a paucity of information regarding paediatric cohorts. Additionally, there is considerable heterogeneity surrounding the reported incidence of PTE following childhood TBI in the current literature. The primary aim of our study is to summarise reported PTE incidences in paediatric populations to derive an accurate estimate of the global incidence of PTE following childhood TBI. Our secondary aim is to explore risk factors that increase the likelihood of developing PTE. METHODS AND ANALYSIS A systematic literature search of Embase (1947-2021), PubMed (1996-2021) and Web of Science (1900-2021) will be conducted. Publications in English that report the incidence of PTE in populations under 18 years of age will be included. Publications that evaluate fewer than 10 patients, report an alternative cause of epilepsy, or in which a paediatric cohort is not discernable, will be excluded. Independent investigators will identify the relevant publications, and discrepancies will be adjudicated by a third independent investigator. Data extracted will include incidence of PTE, time intervals between TBI and PTE, seizure characteristics, injury characteristics, patient demographics and clinical data. Data extraction will be performed by two independent investigators and cross-checked by a third investigator. A descriptive analysis of PTE incidence will be conducted and a weighted mean will be calculated. If sufficient data are available, stratified meta-analysis of subgroups will also be conducted. ETHICS AND DISSEMINATION Ethics approval was not required for this study. We intend to publish our findings in a high-quality peer-reviewed journal on completion. PROSPERO REGISTRATION NUMBER CRD42021245802.
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Affiliation(s)
| | - Sarah S Rewell
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bridgette D Semple
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
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Yu T, Liu X, Sun L, Wu J, Wang Q. Clinical characteristics of post-traumatic epilepsy and the factors affecting the latency of PTE. BMC Neurol 2021; 21:301. [PMID: 34348691 PMCID: PMC8340486 DOI: 10.1186/s12883-021-02273-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/09/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives To summarize the clinical characteristics of post-traumatic epilepsy (PTE), and to identify the factors affecting the latency of PTE after traumatic brain injury (TBI). Methods We conducted a retrospective clinical analysis in patients with PTE who visited the outpatient Department of Epilepsy, Beijing Tiantan Hospital from January 2013 to December 2018. The clinical characteristics, including gender, age distribution, seizure type, and latency were summarized. Factors affecting the latency of PTE were evaluated using Kaplan-Meier curves and Cox proportional hazard regression analysis. Results Complete clinical information was available for 2862 subjects, of which 78.48% were males. The mean age at TBI was 21.4 ± 15.1 years and peaked in the 0 to 12-year-old and 15 to 27-year-old groups. Generalized onset seizure was the most frequent seizure type (72.82% of patients). Approximately 19.95% PTE patients developed drug-resistant epilepsy. The latency of PTE ranged from 8 days to 20 years, with a median of 24.0 (IQR, 5.0–84.0) months. The Kaplan-Meier curves demonstrated that gender, age at TBI, severity of TBI, multiple craniocerebral injuries, post-TBI treatments, acute seizures, and residual disability were associated with PTE latency. The Cox regression model indicated that age ≥ 18 years old, severe TBI with multiple surgical operations, acute seizures, and residual disability were risk factors for shorter PTE latency. Conclusions PTE is more common in males than females, and peaked in the 0 to 12-year-old and 15 to 27-year-old groups. Generalized onset seizure was the most common seizure type and 19.95% of participants developed drug-resistant epilepsy. Patients aged ≥18 years old, who suffered severe TBI followed by multiple surgical operations, experienced acute seizures, or with residual disabilities had shorter PTE latency.
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Affiliation(s)
- Tingting Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, P. R. China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, P. R. China
| | - Xiao Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, P. R. China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, P. R. China
| | - Lei Sun
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, P. R. China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, P. R. China
| | - Jianping Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, P. R. China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, P. R. China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100070, P. R. China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, P. R. China. .,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, P. R. China. .,Beijing Institute for Brain Disorders, Beijing, 100069, P. R. China.
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French JA, Bebin M, Dichter MA, Engel J, Hartman AL, Jóźwiak S, Klein P, McNamara J, Twyman R, Vespa P. Antiepileptogenesis and disease modification: Clinical and regulatory issues. Epilepsia Open 2021; 6:483-492. [PMID: 34270884 PMCID: PMC8408600 DOI: 10.1002/epi4.12526] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/05/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
This is a summary report of clinical and regulatory issues discussed at the 2018 NINDS workshop, entitled “Accelerating Therapies for Antiepileptogenesis and Disease Modification.” The intent of the workshop was to optimize and accelerate development of therapies for antiepileptogenesis (AEG) and disease modification in the epilepsies. The working group discussed nomenclature for antiepileptogenic therapies, subdividing them into “antiepileptogenic therapies” and “disease modifying therapies,” both of which are urgently needed. We use the example of traumatic brain injury to explain issues and complexities in designing a trial for disease‐preventing antiepileptogenic therapies, including identifying timing of intervention, selecting the appropriate dose, and the need for biomarkers. We discuss the recent trials of vigabatrin to prevent onset and modify epilepsy outcome in children with tuberous sclerosis (Epistop and PreVeNT). We describe a potential approach to a disease modification trial in adults, using patients with temporal lobe epilepsy. Finally, we discuss regulatory hurdles for antiepileptogenesis and disease‐modifying trials.
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Affiliation(s)
| | - Martina Bebin
- UAB School of Medicine and UAB Epilepsy Center, Birmingham, AL, USA
| | | | - Jerome Engel
- David Geffen School of Medicine at, UCLA and the Brain Research Institute, Los Angeles, CA, USA
| | - Adam L Hartman
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke/NIH, Bethesda, MD, USA
| | - Sergiusz Jóźwiak
- Department of Child Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | - James McNamara
- Department of Neurobiology, Duke University School of Medicine, Durham, NC, USA
| | | | - Paul Vespa
- Departments of Neurology and Neurosurgery, David Geffen School of Medicine UCLA, Los Angeles, CA, USA
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Omalu B, Hammers J. Letter: Traumatic Encephalopathy Syndrome [TES] Is Not Chronic Traumatic Encephalopathy [CTE]: CTE Is Only a Subtype of TES. Neurosurgery 2021; 89:E205-E206. [PMID: 34271585 DOI: 10.1093/neuros/nyab231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bennet Omalu
- Department of Medical Pathology and Laboratory Medicine University of California, Davis Davis, California, USA
| | - Jennifer Hammers
- Forensic Science and Law Program Bayer School of Natural and Environmental Sciences Duquesne University Pittsburgh, Pennsylvania, USA
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Jalloul D, Hajjar H, Asdikian R, Maawie M, Nasrallah L, Medlej Y, Darwich M, Karnib N, Lawand N, Abdel Rassoul R, Wang KKW, Kobeissy F, Darwish H, Obeid M. Potentiating Hemorrhage in a Periadolescent Rat Model of Closed-Head Traumatic Brain Injury Worsens Hyperexcitability but Not Behavioral Deficits. Int J Mol Sci 2021; 22:6456. [PMID: 34208666 PMCID: PMC8234967 DOI: 10.3390/ijms22126456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 12/29/2022] Open
Abstract
Post-traumatic epilepsy (PTE) and neurocognitive deficits are devastating sequelae of head injuries that are common in adolescents. Investigating desperately needed treatments is hindered by the difficulties in inducing PTE in rodents and the lack of established immature rat models of pediatric PTE. Hemorrhage is a significant risk factor for PTE, but compared to humans, rats are less prone to bleeding because of their rapid blood coagulation system. In this study, we promoted bleeding in the controlled cortical impact (CCI) closed-head injury model with a 20 min pre-impact 600 IU/kg intraperitoneal heparin injection in postnatal day 35 (P35) periadolescent rats, given the preponderance of such injuries in this age group. Temporo-parietal CCI was performed post-heparin (HTBI group) or post-saline (TBI group). Controls were subjected to sham procedures following heparin or saline administration. Continuous long-term EEG monitoring was performed for 3 months post-CCI. Sensorimotor testing, the Morris water maze, and a modified active avoidance test were conducted between P80 and P100. Glial fibrillary acidic protein (GFAP) levels and neuronal damage were also assessed. Compared to TBI rats, HTBI rats had persistently higher EEG spiking and increased hippocampal GFAP levels (p < 0.05). No sensorimotor deficits were detected in any group. Compared to controls, both HTBI and TBI groups had a long-term hippocampal neuronal loss (p < 0.05), as well as contextual and visuospatial learning deficits (p < 0.05). The hippocampal astrogliosis and EEG spiking detected in all rats subjected to our hemorrhage-promoting procedure suggest the emergence of hyperexcitable networks and pave the way to a periadolescent PTE rat model.
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Affiliation(s)
- Dounya Jalloul
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.J.); (H.H.); (R.A.); (Y.M.); (N.K.); (N.L.)
| | - Helene Hajjar
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.J.); (H.H.); (R.A.); (Y.M.); (N.K.); (N.L.)
| | - Rita Asdikian
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.J.); (H.H.); (R.A.); (Y.M.); (N.K.); (N.L.)
| | - Mariam Maawie
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 6573/14, Lebanon; (M.M.); (R.A.R.)
| | - Leila Nasrallah
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut 1107 2020, Lebanon;
| | - Yasser Medlej
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.J.); (H.H.); (R.A.); (Y.M.); (N.K.); (N.L.)
| | - Mouhamad Darwich
- Division of Child Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
| | - Nabil Karnib
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.J.); (H.H.); (R.A.); (Y.M.); (N.K.); (N.L.)
| | - Nada Lawand
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.J.); (H.H.); (R.A.); (Y.M.); (N.K.); (N.L.)
- Department of Neurology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Ronza Abdel Rassoul
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 6573/14, Lebanon; (M.M.); (R.A.R.)
| | - Kevin K. W. Wang
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA;
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut 1107 2020, Lebanon;
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA;
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Hala Darwish
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.J.); (H.H.); (R.A.); (Y.M.); (N.K.); (N.L.)
- Rafic Hariri School of Nursing, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Makram Obeid
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.J.); (H.H.); (R.A.); (Y.M.); (N.K.); (N.L.)
- Division of Child Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
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Conditioned Contextual Freezing is A Neurobehavioral Biomarker of Axonal Injury Indicated by Reduced Fractional Anisotropy in A Mouse Model of Blast-Induced Mild Traumatic Brain Injury. Shock 2021; 53:744-753. [PMID: 31689268 DOI: 10.1097/shk.0000000000001424] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mild traumatic brain injury (TBI) is an important public health problem generated by closed head injury. This study is focused on the impact of blast-induced mild TBI on auditory trace and delay fear conditioning, models of declarative and non-declarative memory, respectively, and the correlation of conditioned freezing and fractional anisotropy, a measure of axonal state. A supersonic helium pressure wave was generated by a shock tube to blast 8-week-old male mice on Day 1 for 1.4 msec with an incident pressure of 16 psi, corresponding to a reflected pressure of 56.9 psi at the mouse head. On Day 3, the mice were subjected to auditory trace- or delay-fear conditioning. On Day 4, contextual freezing in the trained context, and precue and cued freezing in a novel context were determined. After cardiac perfusion on Day 5, ex vivo images were obtained with diffusion tensor imaging at 14.1 Tesla. We observed that delay fear conditioning prevented or reversed the decrease in fractional anisotropy in both the medial and lateral corpus callosum suggesting axonal stabilization of potentially behavioral therapeutic significance. Moderately strong and statistically significant Pearson correlations were found between fractional anisotropy and contextual freezing in the medial and lateral corpus callosum of blasted and sham-blasted delay- or trace-fear conditioned mice. Thus, contextual freezing is a neurobehavioral biomarker for axonal injury in mild TBI and is a reliable and high-throughput behavioral assay for the evaluation of potential therapeutics to treat mild TBI.
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Risk factors for post-traumatic epilepsy. Seizure 2021; 89:81-84. [PMID: 34023655 DOI: 10.1016/j.seizure.2021.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of the current study was to investigate the risk factors for post-traumatic epilepsy (PTE) in a large cohort of patients after severe non-penetrating civilian traumatic brain injury (TBI). METHODS This was a longitudinal study. All patients with a severe non-penetrating TBI, who were admitted at the neuro-intensive care unit of Shahid Rajaee Trauma Hospital, affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, from 2015 until 2019, were studied. Severe TBI was defined as a Glasgow Coma Scale-Motor score below six. Post-traumatic epilepsy was defined as any seizures that occurred after being discharged from the hospital. RESULTS In total, 803 patients with severe non-penetrating TBI were studied; 82 patients (10.2%) reported any late post-traumatic seizures (PTSs). A higher Glasgow outcome scale (extended) at discharge was significantly inversely associated with PTE [Odds Ratio (OR)= 0.76, 95% Confidence Interval (CI): 0.65-0.87; p = 0.0001]. Depressed skull fracture (OR= 1.88, 95% CI: 0.92-3.80; p = 0.081), epi‑dural hematoma (OR= 1.67, 95% CI: 0.93-2.97; p = 0.083), and sub-dural hematoma (OR= 1.64, 95% CI: 0.96-2.78; p = 0.068) were associated with PTE as trends. CONCLUSION Our study adds to the literature on the risk of PTE after severe non-penetrating civilian TBI. Our large sample size and also the application of a logistic regression analysis model may suggest that other variables (e.g., depressed skull fracture and intracranial hematoma) are indeed associated with the Glasgow outcome scale (extended) at discharge and that is why they lost their significance in the model.
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Asadi-Pooya AA, Farazdaghi M. Is severe head injury associated with functional (psychogenic) seizures? Seizure 2021; 89:38-40. [PMID: 33979742 DOI: 10.1016/j.seizure.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/03/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of the current study was to compare the frequency of significant head injuries in three groups of people with seizures [idiopathic generalized epilepsies (IGE) vs. temporal lobe epilepsy (TLE) vs. functional seizures (FS)]. METHODS This was a retrospective study. All patients with a diagnosis of IGE, TLE, or FS were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. RESULTS One thousand and four hundred ninety-two patients were studied (559 patients with IGE, 646 people with TLE, and 287 persons with FS). Overall, 77 (5.2%) individuals of the studied people reported experiencing severe head injuries before the onset of their seizures [9 patients (1.6%) with IGE, 56 people (8.7%) with TLE, and 12 persons (4.2%) with FS; p = 0.0001]. Compared to people with IGE, the odds ratio of having a premorbid history of severe head injury in the FS group was 2.67 [95% Confidence Interval (CI): 1.11-6.40; p = 0.0280]. Compared to people with TLE, the odds ratio of having a premorbid history of severe head injury in the FS group was 0.46 (95% CI: 0.24-0.87; p = 0.0170). CONCLUSION Severe head injury is significantly associated with FS. However, since head injury is also a significant risk factor for focal epilepsies, it may be necessary to ascertain the diagnosis of post-traumatic seizures by obtaing a detailed clinical history and also by performing video-EEG monitoring in order to adopt an appropriate treatment strategy in these patients.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Identification of clinically relevant biomarkers of epileptogenesis - a strategic roadmap. Nat Rev Neurol 2021; 17:231-242. [PMID: 33594276 DOI: 10.1038/s41582-021-00461-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 01/31/2023]
Abstract
Onset of many forms of epilepsy occurs after an initial epileptogenic insult or as a result of an identified genetic defect. Given that the precipitating insult is known, these epilepsies are, in principle, amenable to secondary prevention. However, development of preventive treatments is difficult because only a subset of individuals will develop epilepsy and we cannot currently predict which individuals are at the highest risk. Biomarkers that enable identification of these individuals would facilitate clinical trials of potential anti-epileptogenic treatments, but no such prognostic biomarkers currently exist. Several putative molecular, imaging, electroencephalographic and behavioural biomarkers of epileptogenesis have been identified, but clinical translation has been hampered by fragmented and poorly coordinated efforts, issues with inter-model reproducibility, study design and statistical approaches, and difficulties with validation in patients. These challenges demand a strategic roadmap to facilitate the identification, characterization and clinical validation of biomarkers for epileptogenesis. In this Review, we summarize the state of the art with respect to biomarker research in epileptogenesis and propose a five-phase roadmap, adapted from those developed for cancer and Alzheimer disease, that provides a conceptual structure for biomarker research.
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Karlander M, Ljungqvist J, Zelano J. Post-traumatic epilepsy in adults: a nationwide register-based study. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-325382. [PMID: 33687971 PMCID: PMC8142432 DOI: 10.1136/jnnp-2020-325382] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/16/2021] [Accepted: 02/10/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is a leading cause of epilepsy. Our aim was to characterise the risk of epilepsy in adults after hospitalisation for TBI. METHODS Register-based cohort study. All individuals aged 18-100 with a first hospitalisation for TBI in the comprehensive national patient register in Sweden between 2000 and 2010 (n=111 947) and three controls per exposed (n=325 881), matched on age and sex were included. Exposed individuals were categorised according to TBI severity. Kaplan-Meier curves were used to estimate the risk of epilepsy and Cox regression to estimate the hazard in univariate or multivariate regression. RESULTS The 10-year risk of epilepsy was 12.9% (95% CI 11.7% to 14.1%) for focal cerebral injuries, 8.1% (95% CI 7.5% to 8.7%) for diffuse cerebral injuries, 7.3% (95% CI 6.9% to 7.7%) for extracerebral injuries, 2.8% (95% CI 2.4% to 3.2%) for skull fractures and 2.6% (95% CI 2.4% to 2.8%) for mild TBI. The risk of epilepsy after any TBI was 4.0% (95% CI 3.8% to 4.2%). The corresponding 10-year risk for controls was 0.9% (95% CI 0.9% to 0.9%). The HR increased with a more severe injury, from 3.0 (95% CI 2.8 to 3.2) for mild injury to 16.0 (95% CI 14.5 to 17.5) for focal cerebral injury. Multivariable analyses identified central nervous system (CNS) comorbidities as risk factors, but TBI remained significant also after adjustment for these. Other identified risk factors were male sex, age, mechanical ventilation and seizure during index hospitalisation. CONCLUSION The risk of post-traumatic epilepsy is considerable, also with adjustments for CNS comorbidities.
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Affiliation(s)
- Markus Karlander
- Department of Clinical Neuroscience, University of Gothenburg Institute of Neuroscience and Physiology, Gothenburg, Sweden
- Neurology, Södra Älvsborgs Hospital Borås, Boras, Sweden
| | - Johan Ljungqvist
- Department of Clinical Neuroscience, University of Gothenburg Institute of Neuroscience and Physiology, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Zelano
- Department of Clinical Neuroscience, University of Gothenburg Institute of Neuroscience and Physiology, Gothenburg, Sweden
- Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Center for Molecular and Translational Medicine, Gothenburg University, Gothenburg, Sweden
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Lenio S, Kerr WT, Watson M, Baker S, Bush C, Rajic A, Strom L. Validation of a predictive calculator to distinguish between patients presenting with dissociative versus epileptic seizures. Epilepsy Behav 2021; 116:107767. [PMID: 33545649 PMCID: PMC7951947 DOI: 10.1016/j.yebeh.2021.107767] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 01/30/2023]
Abstract
Dissociative seizures (also known as psychogenic nonepileptic seizures) are a common functional neurological disorder that can be difficult to distinguish from epileptic seizures. Patients with dissociative seizures provide diagnostic challenges, leading to delays in care, inappropriate care, and significant healthcare utilization and associated costs. The dissociative seizure likelihood score (DSLS) was developed by Kerr and colleagues at UCLA to distinguish between patients with epileptic seizures and dissociative seizures based on clinical and medication history as well as features of seizure semiology. We validated this calculator at the University of Colorado, which is a Level 4 National Association of Epilepsy Center. The DSLS accurately predicted the diagnosis in 81% of patients, despite local variability in the factors associated with epileptic versus dissociative seizures between the two populations. The DSLS can be a useful tool to assist with history taking and may have important utility for clinical decision making with these difficult to distinguish patient populations.
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Affiliation(s)
- Steven Lenio
- Department of Neurology, University of Colorado, Aurora, CO, USA.
| | - Wesley T Kerr
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Meagan Watson
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Sarah Baker
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Chad Bush
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Alex Rajic
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Laura Strom
- Department of Neurology, University of Colorado, Aurora, CO, USA
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Boada CM, French JA, Dumanis SB. Proceedings of the 15th Antiepileptic Drug and Device Trials Meeting: State of the Science. Epilepsy Behav 2020; 111:107189. [PMID: 32563052 DOI: 10.1016/j.yebeh.2020.107189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 12/11/2022]
Abstract
On May 22-24, 2019, the 15th Antiepileptic Drug and Device (AEDD) Trials Conference was held, which focused on current issues related to AEDD development from preclinical models to clinical prognostication. The conference featured regulatory agencies, academic laboratories, and healthcare companies involved in emerging epilepsy therapies and research. The program included discussions around funding and support for investigations in epilepsy and neurologic research, clinical trial design and integrated outcome measures for people with epilepsy, and drug development and upcoming disease-modifying therapies. Finally, the conference included updates from the preclinical, clinical, and device pipeline. Summaries of the talks are provided in this paper, with the various pipeline therapeutics in the listed tables to be outlined in a subsequent publication.
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Affiliation(s)
- Christina M Boada
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Jacqueline A French
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
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Yuan WH, Wang SJ. Posttraumatic epilepsy after traumatic brain injury and prophylactic administration of antiepileptic drugs. J Chin Med Assoc 2020; 83:885-886. [PMID: 32773580 PMCID: PMC7526581 DOI: 10.1097/jcma.0000000000000395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Wei-Hsin Yuan
- Division of Radiology, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Address correspondence: Dr. Wei-Hsin Yuan, Division of Radiology, Taipei Municipal Gan-Dau Hospital, 12, Lane 225, Zhi-Sing Road, Taipei 112, Taiwan, ROC. E-mail address: (W.-H. Yuan)
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
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Fordington S, Manford M. A review of seizures and epilepsy following traumatic brain injury. J Neurol 2020; 267:3105-3111. [PMID: 32444981 PMCID: PMC7501105 DOI: 10.1007/s00415-020-09926-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
Traumatic brain injury (TBI) is one of the commonest presentations to emergency departments and is associated with seizures carrying different significance at different stages following injury. We describe the epidemiology of early and late seizures following TBI, the significance of intracranial haemorrhage of different types in the risk of later epilepsy and the gaps in current understanding of risk factors contributing to the risk of post-traumatic epilepsy (PTE). The delay from injury to epilepsy presents an opportunity to understand the mechanisms underlying changes in the brain and how they may reveal potential targets for anti-epileptogenic therapy. We review existing treatments, both medical and surgical and conclude that current research is not tailored to differentiate between PTE and other forms of focal epilepsy. Finally, we review the increasing understanding of the frequency and significance of dissociative seizures following mild TBI.
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Affiliation(s)
| | - Mark Manford
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK.
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Liou JH, Chang YL, Lee HT, Wu MF, Hou YC, Liou WS. Preventing epilepsy after traumatic brain injury: A propensity score analysis. J Chin Med Assoc 2020; 83:950-955. [PMID: 32858550 PMCID: PMC7526576 DOI: 10.1097/jcma.0000000000000414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Due to the potential consequences of post-traumatic epilepsy (PTE) exacerbating secondary injury following traumatic brain injury (TBI), the use of antiepileptic drugs (AEDs) is an accepted option for seizure prophylaxis. However, there is only a paucity of data that can be found regarding outcomes surrounding the use of AEDs. The purpose of this retrospective study is to evaluate whether the prophylactic administration of AEDs significantly decreased the incidence of PTE, when considering the severity of TBI. METHODS All trauma patients who had been newly diagnosed with TBI from January 1, 2010 to December 31, 2017 were retrospectively analyzed. Statistical comparisons were made using the chi-square test, Mann-Whitney U test, and Cox regression modeling. After excluding any exposed subjects with no appropriate match, patients who had received AED prophylaxis were matched by propensity score with those who did not receive AEDs. All of the TBI populations were followed up until June 30, 2018. RESULTS We identified 1316 patients who met the inclusion and exclusion criteria in our matched cohort through their propensity scores, where 138 patients had been receiving prophylactic AEDs and 138 patients had not. Baseline characteristics were similar in gender, age, Glasgow Coma Scale (GCS) scores, and risk factors of PTE including skull fracture, chronic alcoholism, subdural hematoma, epidural hematoma, and intracerebral hematoma. After adjusting for those risk factors, the relative incidence of seizure was not statistically significant in either of the groups (p = 0.566). CONCLUSION In our cohort analysis, AED prophylaxis was ineffective in preventing seizures, as the rate of seizures was similar whether patients had been receiving the drugs or not. We therefore concluded that the benefits of routine prophylactic anticonvulsant therapy in patients with TBI need to be re-evaluated.
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Affiliation(s)
- Jaw-Horng Liou
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- School of Pharmacy, China Medical University, Taichung, Taiwan, ROC
| | - Yen-Lin Chang
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Hsu-Tung Lee
- Department of Neurosurgery, Neurology of Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Cancer Prevention and Control Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Ming-Fen Wu
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yu-Chi Hou
- School of Pharmacy, China Medical University, Taichung, Taiwan, ROC
| | - Wen-Shyong Liou
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- School of Pharmacy, China Medical University, Taichung, Taiwan, ROC
- Address correspondence. Dr. Wen-Shyong Liou, Department of Pharmacy, Taichung Veterans General Hospital, 1650, Taiwan Boulevard Section 4, Taichung 407, Taiwan, ROC. E-mail address: (W.-S. Liou)
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Siig Hausted H, Nielsen JF, Odgaard L. Epilepsy after severe traumatic brain injury: frequency and injury severity. Brain Inj 2020; 34:889-894. [PMID: 32506958 DOI: 10.1080/02699052.2020.1763467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To estimate national frequency of posttraumatic epilepsy (PTE) after severe traumatic brain injury (TBI) and assess injury severity (Glasgow Coma Scale (GCS) and posttraumatic amnesia (PTA)) as prognostic factors for PTE. METHODS Data on patients ≥18 years surviving severe TBI 2004-2016 were retrieved from the Danish Head Trauma Database (n = 1010). The cumulative incidence proportion (CIP) was estimated using death as competing event. The association between injury severity and PTE was assessed using multivariable competing risk regressions. RESULTS CIP of PTE 28 days and one year post-TBI was 6.8% (95% confidence interval (CI) 5.4-8.5) and 18.5% (95% CI 16.1-21.1%), respectively. Injury severity was not associated with PTE within 28 days post-TBI but indicated higher PTE-rates in less severely injured patients. PTA-duration >70 days was associated with PTE 29-365 days post-TBI (Adjusted sub-hazard ratio 4.23 (95% CI 1.79-9.99)). GCS was not associated with PTE 29-365 days post-TBI. CONCLUSION The PTE frequency was higher compared to previous estimates. Increasing injury severity was associated with PTE 29-365 days post-TBI when measured with PTA, but not with GCS. Though nonsignificant, the increased PTE-risk within 28 days in lower severity suggests an underdiagnosing of PTE.
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Affiliation(s)
- Hanna Siig Hausted
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Aarhus, Denmark
| | - Jørgen F Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Aarhus, Denmark
| | - Lene Odgaard
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Aarhus, Denmark
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