Correlates of posttraumatic epilepsy 35 years following combat brain injury
Correlates of posttraumatic epilepsy 35 years following combat brain injury
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DOI：
10.1212/wnl.0b013e3181e8e6d0
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发表时间：
2010-07-20
期刊：
影响因子：
9.9
通讯作者：
Grafman, J.
中科院分区：
文献类型：
--
作者：
Raymont, V.;Salazar, A. M.;Grafman, J.
背景资料：越南头部损伤研究（VHIS）是对1，221名越南战争退伍军人进行的前瞻性纵向随访，这些退伍军人大多患有穿透性头部损伤（PHIs）。创伤后癫痫（PTE）的高患病率（45%-53%）在这个独特的队列使其成为研究价值。方法：作为本研究第3阶段的一部分，对199名VHIS退伍军人和未受伤的对照组进行了标准化的多学科神经病学、认知、行为和脑成像评估。癫痫发作的患病率（87例患者，43.7%）与20年前2期评估期间发现的相似，但87例患者中有11例（12.6%）报告了2期后（受伤后超过14年）发生的PTE。这些患者与早发性PTE患者在任何研究指标上均无差异。在III期队列中，最常见的癫痫发作类型是复杂部分性癫痫发作（31.0%），损伤后频率增加。在PTE受试者中，88%正在接受抗惊厥药物治疗。在逻辑回归模型中，左顶叶病变和残留的铁金属碎片与PTE相关。总脑容量损失预测癫痫发作频率。结论：PHI患者在受伤后数十年发生PTE的风险很高，因此需要长期的医疗随访。病变部位、病变大小和病变类型是PTE的预测因素。神经病学（R）2010;75：224-229
Background: The Vietnam Head Injury Study (VHIS) is a prospective, longitudinal follow-up of 1,221 Vietnam War veterans with mostly penetrating head injuries (PHIs). The high prevalence (45%-53%) of posttraumatic epilepsy (PTE) in this unique cohort makes it valuable for study.Methods: A standardized multidisciplinary neurologic, cognitive, behavioral, and brain imaging evaluation was conducted on 199 VHIS veterans plus uninjured controls, some 30 to 35 years after injury, as part of phase 3 of this study.Results: The prevalence of seizures (87 patients, 43.7%) was similar to that found during phase 2 evaluations 20 years earlier, but 11 of 87 (12.6%) reported very late onset of PTE after phase 2 (more than 14 years after injury). Those patients were not different from patients with earlier-onset PTE in any of the measures studied. Within the phase 3 cohort, the most common seizure type last experienced was complex partial seizures (31.0%), with increasing frequency after injury. Of subjects with PTE, 88% were receiving anticonvulsants. Left parietal lobe lesions and retained ferric metal fragments were associated with PTE in a logistic regression model. Total brain volume loss predicted seizure frequency.Conclusions: Patients with PHI carry a high risk of PTE decades after their injury, and so require long-term medical follow-up. Lesion location, lesion size, and lesion type were predictors of PTE. Neurology (R) 2010;75:224-229