Early seizures and temporal lobe trauma predict post-traumatic epilepsy: A longitudinal study.
Early seizures and temporal lobe trauma predict post-traumatic epilepsy: A longitudinal study.
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DOI：
10.1016/j.nbd.2018.05.014
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发表时间：
2019-03
影响因子：
6.1
通讯作者：
Vespa PM
中科院分区：
文献类型：
--
作者：
Tubi MA;Lutkenhoff E;Blanco MB;McArthur D;Villablanca P;Ellingson B;Diaz-Arrastia R;Van Ness P;Real C;Shrestha V;Engel J Jr;Vespa PM
创伤性脑损伤 (TBI) 后的损伤严重程度是发生创伤后癫痫 (PTE) 的一个公认的危险因素。然而，病变位置是否纵向影响癫痫发作的易感性和 PTE 的发展尚待确定。我们假设病变位置，特别是颞叶，与早期癫痫发作和 PTE 发生率增加有关。作为次要分析措施，我们评估了脑萎缩和功能恢复的程度，并进行了组间分析，将发生 PTE 的患者与未发生 PTE 的患者进行比较。我们在中重度 TBI 患者的前瞻性方便样本中评估了早期癫痫发作率 (n = 90) 和 PTE 的纵向发展 (n = 46)。首先，通过前瞻性 cEEG 和高分辨率磁共振成像 (MRI) 扫描对患者进行监测，以对病变位置进行分类。长期以来，患者接受了高分辨率 MRI、临床评估，并在受伤后至少 2 年内对癫痫的发展进行纵向监测。 26.7% 的患者 (n = 90) 发生早期癫痫发作，发生在受伤后第一周内。在有早期癫痫发作证据的受试者队列中 (n = 24)，75% 的受试者入院时患有出血性颞叶损伤。纵向分析 (n = 46) 表明，45.7% 的患者在受伤后至少 2 年内发生 PTE。在发生 PTE 的受试者队列中 (n = 21)，85.7% 的人入院时有出血性颞叶损伤，38.1% 的人在急性 ICU 住院期间 cEEG 监测显示早期（惊厥或非惊厥）癫痫发作。在组间分析中，PTE 患者 (n = 21) 比未发生 PTE 的患者 (n = 25) 更有可能出现出血性颞叶损伤 (p < 0.001)、功能恢复更差 (p = 0.003) 和更严重的颞叶萎缩 (p = 0.029)。我们的结果表明，在一组中重度 TBI 患者中，1) 病变位置特异性（例如颞叶）与早期癫痫发作和 PTE 纵向发展的高发生率相关，2) 早期癫痫发作，无论是惊厥性还是非惊厥性，都与 PTE 发展风险增加相关，3) 与那些发生 PTE 的患者相比，发生 PTE 的患者有更严重的慢性颞叶萎缩和更差的功能结果。尽管损伤严重程度特征相匹配，但不会发生 PTE。这项研究为未来的前瞻性研究奠定了基础，重点是阐明癫痫发生的机制和危险因素。
Injury severity after traumatic brain injury (TBI) is a well-established risk factor for the development of post-traumatic epilepsy (PTE). However, whether lesion location influences the susceptibility of seizures and development of PTE longitudinally has yet to be defined. We hypothesized that lesion location, specifically in the temporal lobe, would be associated with an increased incidence of both early seizures and PTE. As secondary analysis measures, we assessed the degree of brain atrophy and functional recovery, and performed a between-group analysis, comparing patients who developed PTE with those who did not develop PTE. We assessed early seizure incidence (n = 90) and longitudinal development of PTE (n = 46) in a prospective convenience sample of patients with moderate-severe TBI. Acutely, patients were monitored with prospective cEEG and a high-resolution Magnetic Resonance Imaging (MRI) scan for lesion location classification. Chronically, patients underwent a high-resolution MRI, clinical assessment, and were longitudinally monitored for development of epilepsy for a minimum of 2 years post-injury. Early seizures, occurring within the first week post-injury, occurred in 26.7% of the patients (n = 90). Within the cohort of subjects who had evidence of early seizures (n = 24), 75% had a hemorrhagic temporal lobe injury on admission. For longitudinal analyses (n = 46), 45.7% of patients developed PTE within a minimum of 2 years post-injury. Within the cohort of subjects who developed PTE (n = 21), 85.7% had a hemorrhagic temporal lobe injury on admission and 38.1% had early (convulsive or non-convulsive) seizures on cEEG monitoring during their acute ICU stay. In a between-group analysis, patients with PTE (n = 21) were more likely than patients who did not develop PTE (n = 25) to have a hemorrhagic temporal lobe injury (p < 0.001), worse functional recovery (p = 0.003), and greater temporal lobe atrophy (p = 0.029). Our results indicate that in a cohort of patients with a moderate-severe TBI, 1) lesion location specificity (e.g. the temporal lobe) is related to both a high incidence of early seizures and longitudinal development of PTE, 2) early seizures, whether convulsive or non-convulsive in nature, are associated with an increased risk for PTE development, and 3) patients who develop PTE have greater chronic temporal lobe atrophy and worse functional outcomes, compared to those who do not develop PTE, despite matched injury severity characteristics. This study provides the foundation for a future prospective study focused on elucidating the mechanisms and risk factors for epileptogenesis.
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影响因子：
4.2
作者：
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通讯作者：
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