A population-based study of seizures after traumatic brain injuries
A population-based study of seizures after traumatic brain injuries
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DOI：
10.1056/nejm199801013380104
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发表时间：
1998-01-01
影响因子：
158.5
通讯作者：
Rocca, WA
中科院分区：
文献类型：
--
作者：
Annegers, JF;Hauser, WA;Rocca, WA
背景创伤性脑损伤后癫痫发作的风险增加，但风险增加的程度和持续时间尚不清楚。本研究的目的是确定与癫痫发作的发展相关的脑损伤的特点，我们确定了4541名儿童和成人的创伤性脑损伤（其特点是意识丧失，创伤后遗忘症，或颅骨骨折）在奥姆斯特德县，明尼苏达州，在1935年至1984年期间。损伤分为轻度（意识丧失或遗忘持续不到30分钟）、中度（意识丧失30分钟至24小时或颅骨骨折）或重度（意识丧失或遗忘超过24小时、硬膜下血肿或脑挫伤）。我们使用标准化发病率和考克斯比例风险分析比较了该队列中新发无端癫痫发作的发病率与人群发病率。结果总体标准化发病率为3.1（95%置信区间为2.5 ~ 3.8）。标化发病比为1.5（95%置信区间，1.0 - 2.2）轻度损伤后，但五年后没有超过预期数量的增加，2.9（95%置信区间，1.9至4.1）中度损伤后，和17.0（95%可信区间，12.3 ~ 23.6），多因素分析显示，脑挫伤伴硬膜下血肿、颅骨骨折、意识丧失或遗忘超过一天，年龄为65岁或以上。结论创伤性脑损伤后癫痫发作的风险增加根据损伤的严重程度和损伤后的时间有很大差异。(C)1998年，马萨诸塞州医学会。
Background The risk of seizures is increased after traumatic brain injury, but the extent and duration of the increase in risk are unknown. The purpose of this study was to identify the characteristics of brain injuries that are associated with the development of seizures.Methods We identified 4541 children and adults with traumatic brain injury (characterized by loss of consciousness, post-traumatic amnesia, or skull fracture) in Olmsted County, Minnesota, during the period from 1935 through 1984. Injuries were classified as mild (loss of consciousness or amnesia lasting less than 30 minutes), moderate (loss of consciousness for 30 minutes to 24 hours or a skull fracture), or severe (loss of consciousness or amnesia for more than 24 hours, subdural hematoma, or brain contusion). We compared the incidence of new unprovoked seizures in this cohort with population rates, using standardized incidence ratios and Cox proportional-hazards analysis.Results The overall standardized incidence ratio was 3.1 (95 percent confidence interval, 2.5 to 3.8). The standardized incidence ratio was 1.5 (95 percent confidence interval, 1.0 to 2.2) after mild injuries but with no increase over the expected number after five years, 2.9 (95 percent confidence interval, 1.9 to 4.1) after moderate injuries, and 17.0 (95 percent confidence interval, 12.3 to 23.6) after severe injuries, In the multivariate analysis, significant risk factors for later seizures were brain contusion with subdural hematoma, skull fracture, loss of consciousness or amnesia for more than one day, and an age of 65 years or older.Conclusions The increased risk of seizures after traumatic brain injury varies greatly according to the severity of the injury and the time since the injury. (C) 1998, Massachusetts Medical Society.