The Effect of Keppra Prophylaxis on the Incidence of Early Onset, Post-traumatic Brain Injury Seizures.
The Effect of Keppra Prophylaxis on the Incidence of Early Onset, Post-traumatic Brain Injury Seizures.
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DOI：
10.7759/cureus.2674
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发表时间：
2018-05-23
期刊：
影响因子：
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通讯作者：
Chin LS
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作者：
Hazama A;Ziechmann R;Arul M;Krishnamurthy S;Galgano M;Chin LS
目的：外伤性脑损伤（TBI）是导致长期残疾的主要原因。脑外伤后早发性创伤后癫痫发作（PTS）是这些患者不良结局的一个强有力的预测因子。我们的研究将损伤严重程度、癫痫发作史和抗癫痫药物（AED）使用等危险因素考虑在内，研究了Keppra在早期PTS预防中的作用，并与未治疗进行了比较。方法：这是一项回顾性队列研究，基于2013年1月至2017年1月在美国一级创伤中心的患者图表数据。进行t检验，P<0.05为显著性；我们使用95%的置信区间（CI）对我们的发现。进行格拉斯哥昏迷评分（GCS）亚组分析（A组：轻度GCS=13-15, Keppra N=135，非Keppra N=122； B组：中度GCS=9-12, Keppra N=23，非Keppra N=19； C组：重度GCS= <8, Keppra N=69，非Keppra=35）。结果：纳入研究的403例患者中，有227例患者接受了Keppra治疗。治疗组之间的人口统计数据相似。全队列分析证实6例PTS患者，组间差异无统计学意义（Keppra N=3, Non-Keppra N=3， OR=0.77， P=0.75, 95% CI=(0.154-3.87)）。亚组分析显示，Keppra A组（OR=0.18， P=0.27, 95% CI=(0.008-3.80)）和B组（OR=0.82， P=0.92, 95% CI=(0.015-43.7)）癫痫发作发生率降低，但差异无统计学意义。C组严重TBI患者占癫痫发作的大多数（n=4， OR=1.52， P=0.71, 95% CI=(0.15-15.4)）。结论：颅脑损伤越严重，早发性创伤后癫痫发作的发生率越高。整个队列的数据显示，接受Keppra预防治疗的患者癫痫发作发生率较低。尽管有这种趋势，但癫痫发作发生率的下降并没有达到统计学意义。
Objective: Traumatic brain injury (TBI) is a leading cause of long-term disability. Early onset post-traumatic seizures (PTS) after traumatic injury to the brain is a strong predictor of adverse outcomes in these patients. Our study investigates the role of Keppra in early PTS prophylaxis compared to no treatment, taking into account risk factors including injury severity, seizure history, and anti-epileptic drug (AED) use. Methods: This was a retrospective cohort study based on patient chart data from January 2013 to January 2017 at a level one trauma center in the United States. A t-test was performed with P<0.05 as significant; we utilized a 95% confidence interval (CI) for our findings. Subgroup analysis was performed, with respect to the Glasgow Coma Scale (GCS) score (Group A: Mild GCS=13-15, Keppra N=135, Non-Keppra N=122; Group B: Moderate GCS=9-12, Keppra N=23, Non-Keppra N=19; Group C: Severe GCS= <8, Keppra N=69, Non-Keppra=35). Results: Of 403 patients included in the study, 227 were given Keppra. Demographics between treatment groups were similar. Whole cohort analysis confirmed six patients with PTS, and no significant difference between groups (Keppra N=3, Non-Keppra N=3, OR=0.77, P=0.75, 95% CI=(0.154-3.87)). Subgroup analysis revealed reduction in seizure incidence in Keppra groups A (OR=0.18, P=0.27, 95% CI=(0.008-3.80)) and B (OR=0.82, P=0.92, 95% CI=(0.015-43.7)), but this reduction was not statistically significant. Those with the severe TBI in group C accounted for the majority of seizures (n=4, OR=1.52, P=0.71, 95% CI=(0.15-15.4)). Conclusion: Patients with more severe TBI suffered a higher incidence of early-onset post-traumatic seizures. Data of the cohort as a whole revealed a trend towards a lower seizure incidence in patients who were treated with Keppra prophylaxis. Despite this trend, the decrease in seizure incidence did not reach statistical significance.