Posttraumatic

seizures
..

Post trauma serizures

I Impact seizures : within 24 hours
II Early seizures : within 1 week
III Late seizures : more than 8 days

Sequence of seizures
: Hypoxia

: Increased metabolic demand

: Hypertension

: Metabolic changes

: Increased IC hypertension

: Excess neurotransmitter

: Unconscious

release

Incidence :
PTE

related to severity of injury 3%-5% in

the first year
12 times as great as for the population
Severe head trauma, cortical injury,
neurologi deficit and

- dura intact ; 7% -39%

- dura penetration ; 20%-57%

Early PTS
Incidence

2%-7%
Unselected patients with head injury ~ 2%
Consecutive admissions ~3%-6%
Young children under 5 years ~7%-9%
Severe head injury ~ 30%
Mild head injury ~ 1-2 %
SDH and ICH ~1/3
EDH, depressed skull fracture and prolong
amnesia ~10%

Late PTS
Incidence

1.6% - 5%
25% of early seizure or ICH developed to
late seizures
Mild head injury ~ 1-2%
Cranial missile wound ~1/3-1/2

Timing of Early PTS

1/3

within first hour

1/3 between 1-24 hours
1/3 between 1-7 days after injury
Timing of Late PTS
18% in first moth
57% in first year

Factors Associated with early post-traumatic seizures*

Incidence of Early
Post-traumatic Seizures
(per Cent)
Depressed skull fracture
27
Subdural hematoma
24
Intracerebral head injury
23
Penetrating head injury
20
Glasgow Coma Scale score less than or
equal to 10
Epidural hematoma
17
Cortical contusion
16
Immediate seizures
28+
Linear fracture23
6
Post- traumatic amnesia greater than 24 hr 23
No or brief unconsciousness 23
6
No or brief unconsciousness, age younger
than 5 yr23

20

12
17

Factors Associated with late post-traumatic seizures*

Incidence of Late
Post-traumatic Seizures
(per Cent)
Penetrating missile wound44
53
Early seizures
47
Intracerebral hematoma
40
Subdural hematoma
33
Glasgow Coma Scale score less than or
equal to 10
Depressed skull fracture
31
Cortical contusion
28
Epidural hematoma
26
Linear fracture26
5
Mild concussion23
<1

32

Seizures type of Early PTS

60%-80%

focal seizure (more common in

children or missile injury)

20%-40%

seizures

10%

generalized tonic clonic

of adult and 20% of children younger

than 5 years with early seizures developed
status epilepticus

Seizures type of late PTS

60%-70%

are generalized seizures, with

or without focal onset

30%-40%

seizures

are simple or complex partial

Prevention and Prophylaxis

Ideally

; prophylaxis should aim at

reducing the chance of developing PTE
with drug treatment

Aims

; ADEs prevention of early seizures

after severe head trauma , to avoid
complication

Prevention and Prophylaxis

Clinical

observation (1970-1979)

Young

et al, Wohn and Wyler concluded that

antiepileptic drug prevented the development
of PTS

Risk

and Caveness no difference in early

seizures occurrence between AEDs-treated
and untreated patients

 Prospective

double blind with placebo control

Penry

and colleagues (1979)

;serizures occurrence in the treated group 21%
versus 13% in control
Young

et al (1983)
; 179 cases, 85 were treated (18 mo) 74 were control
Seizures occurred 12.9% of treated and in 10.8% of
the control patients

Temkin et al
At

first year, no difference in incidence of

PTS between the treatment and control
groups
By 2 years, PTS occurred in 27.5% of
phenytoin treated patients and in 21.1% of
control patients
Observe that phenytoin was effective in
preventing seizures during immediatedly
after injury (1 or 2 weeks)

The New England Journal of

Medicine (1990) (Temkin)
Randomized,

double blind study for prevention of

PTE 404 patients, treatment patients 208, control
196
Treatment
3.6%

Placebo
14.2%

Day 8 end of
Year 1

21.5%

17.5

At the end of
Year 2

27.5%

21.1%

Day 1- day 7

Phenytoin

exerts beneficial effect by reducing

seizures only during the first week

walker and Erculei ; 50% have PTE would be

in complete remission by 15 years after injury
Remission of epilepsy is safer term than
cessation
2 years without seizure is a reasonable
definition of remission
Clinicians recommend discontinuation of
AEDs in adults after 2 years without epilepsy
Intractable epilepsy ; should evaluation the
patient for resective surgery

Conclusion
Routinely

prophylactic treatment with

AEDs, IV loading dose as soon as
possible after injury
Should

not routinely be used beyond the first

7 days
Use AEDs in late PTE when ; early PTE or
have seizures after 7 days
Stop AEDs after 2 years without seizures