Repeated traumatic brain injury and risk of epilepsy: a Danish nationwide cohort study
Repeated traumatic brain injury and risk of epilepsy: a Danish nationwide cohort study
复制标题
DOI：
10.1093/brain/awaa448
复制
发表时间：
2021-01-13
期刊：
影响因子：
14.5
通讯作者：
Christensen, Jakob
中科院分区：
文献类型：
--
作者：
Lolk, Kasper;Dreier, Julie W.;Christensen, Jakob
创伤性脑损伤与癫痫风险增加有关，但反复创伤性脑损伤的重要性尚未确定。我们对1977年至2016年在丹麦出生的2476905人进行了一项基于全国人口的队列研究。我们分别使用Cox和竞争风险回归估计创伤性脑损伤后癫痫的风险比（hr）和累积发病率。为了估计无外伤性脑损伤人群中癫痫的累积发病率，我们根据出生年份、性别和索引人脑损伤的日期，为每名外伤性脑损伤受试者匹配10名对照。在队列中，167051名受试者（女性71162人，男性95889人）遭受创伤性脑损伤，37200人发生癫痫（女性17905人，男性19295人）。与无创伤性脑损伤的受试者相比，第一次创伤性脑损伤后癫痫的相对风险增加[HR 2.04, 95%可信区间（CI） 1.96-2.13]，第二次创伤性脑损伤后癫痫的相对风险更高（HR 4.45, 95% CI 4.09-4.84）。危险性随第一次和第二次创伤性脑损伤的严重程度而增加，尤其是在严重创伤性脑损伤后。女性比男性更容易在轻度创伤性脑损伤后发生癫痫(HR 2.13, 95% CI 2.00-2.28 vs HR 1.77, 95% CI 1.66-1.88
Traumatic brain injury is associated with increased risk of epilepsy, but the importance of repeated traumatic brain injuries has not yet been established. We performed a nationwide population-based cohort study of 2476905 individuals born in Denmark between 1977 and 2016. We estimated hazard ratios (HRs) and the cumulative incidence of epilepsy following traumatic brain injury using Cox and competing risk regression, respectively. To estimate the cumulative incidence of epilepsy in the population without traumatic brain injury, we matched 10 controls for each subject with traumatic brain injury on year of birth, sex, and date of brain insult in the index person. In the cohort, traumatic brain injury was sustained by 167051 subjects (71162 females and 95889 males), and 37200 individuals developed epilepsy (17905 females and 19295 males). Compared with subjects without traumatic brain injury, the relative risk of epilepsy increased after a first traumatic brain injury [HR 2.04, 95% confidence interval (CI) 1.96-2.13] and even more after a second traumatic brain injury (HR 4.45, 95% CI 4.09-4.84). The risk increased with the severity of the first and the second traumatic brain injury, most notably after severe traumatic brain injuries. Females were more likely than males to develop epilepsy after mild traumatic brain injury (HR 2.13, 95% CI 2.00-2.28 versus HR 1.77, 95% CI 1.66-1.88; P