Research advances in the pathogenesis of post-traumatic epilepsy / 中风与神经疾病杂志

@#Post-traumatic epilepsy （PTE） is the most common type of structural epilepsy. Revealing the mechanism of PTE may help to perform early targeted intervention， reduce related risks， and improve the prognosis of patients. This review summarizes the main hypotheses on the mechanism of PTE， including： （1） The breakdown of the blood-brain barrier after traumatic brain injury （TBI） causes serum protein extravasation and thus increases excitatory amino acids； （2） TBI activates neuroinflammation and the production of inflammatory mediators interferes with the balance between excitatory and inhibitory transmitters； （3） TBI leads to neurodegeneration and the mass production of Tau protein and the amyloid proteins APP and Aβ increases the excitability of hippocampal neurons； （4） abnormalities in aquaporin-4， brain-derived neurotrophic factor， and/or intestinal microbiota after TBI result in axonal sprouting and increase the activity of excitatory transmitters. Further exploration of the pathogenesis of PTE can help to find more disease-modifying treatment methods and provide new ideas for the treatment of PTE.

Analysis of long-term surgical outcome and safety in patients with post-traumatic epilepsy / 中风与神经疾病杂志

@#Objective To investigate the long-term surgical outcome and safety of resective surgical treatment in patients with post-traumatic epilepsy(PTE). Methods Patients with PTE who underwent resective surgery from January 2014 to December 2020 at our center were consecutively included,and their demographic characteristics and clinical data were retrospectively analyzed. Univariate analysis and multifactor Logistic regression analysis were used to identify potential predictors of postoperative outcome,and surgery-related complications were documented and followed-up. Results A total of 104 patients with PTE were included. The postoperative outcomes were graded by Engel class:60.6%(63/104) as Engel class Ⅰ and 39.4%(41/104) as Engel class Ⅱ-Ⅳ with a mean follow-up of(68.7±23.2) months(20-103 months). Univariate analysis showed that age at the time of surgery and surgical side were associated with postoperative outcome,while multivariate analysis showed that only surgical side was an independent predictor of postoperative outcome(OR=2.944,95%CI 1.283-6.753,P=0.011),with 2.9 times the seizure-free(Engel class Ⅰ) rate when the surgical side was right-sided compared with left-sided. 29.8%(31/104) of patients had varying degrees of surgery-related complications,including 20 cases of subcutaneous or subdural effusion;3 cases of cerebral edema;2 cases of cerebral hemorrhage;1 case of hydrocephalus combined with incisional infection;and 5 cases of neurological deficits,4 of which recovered completely during the follow-up period. Conclusion PTE patients treated with resective surgery after comprehensive preoperative evaluation had good long-term surgical outcomes and safety,and good postoperative outcomes were predicted when the surgical side was right-sided.

α-Helical protein absorption at post-traumatic epileptic foci monitored by Fourier transform infrared mapping

Tissue analysis by Fourier transform infrared (FTIR) imaging can determine the biodistribution of molecules,without pre-analytical modification. We aimed to study the infrared spectroscopic changes of a-helical proteinsat post-traumatic epileptic (PTE) foci by FTIR. FITR mapping was applied to detect a-helical proteins in ratbrain tissue samples with post-traumatic epilepsy. Histological examination of brain sections showed that therat model of PTE was successfully established. At the PTE foci, high a-helical absorption regions wereevident, where the color difference and absorption were significantly different from those in the low-absorptionregions. This provided a distinctive and characteristic pattern at the site of lesions. The use of FTIR imagingmeans that it is possible to measure the molecular structural changes resulting from PTE pathologies in tissues,providing a novel adjunct to conventional pathological diagnostic techniques.

Severe Hyponatraemia under Carbamazepine for Secondary Prophylaxis of Post-Traumatic Epilepsy.

Aims: Among the antiepileptic drugs (AEDs) applied for secondary prophylaxis of posttraumatic epilepsy (PTE), carbamazepine (CBZ) may cause severe side effects and worsen traumatic brain injury (TBI). Presentation of Case: Two days after a bicycle accident causing severe TBI, a 23yo female developed a questionable seizure and received CBZ. Since then she required substitution of sodium. Six days after the accident she was extubated. Serum sodium was 123mmol/l. One day after transfer to the general ward, she was found comatose with a serum sodium of 114mmol/l. Cerebral CT showed diffuse cerebral edema. Electroencephalography did not record paroxysmal activity. After replacement of CBZ by levetiracetam, her condition markedly improved with a favourable outcome. Discussion and Conclusion: CBZ was made responsible for severe hyponatraemia in the presented case after exclusion of all other possible causes. Hyponatraemia may trigger the recurrence of cerebral edema after TBI. Hyponatraemia from CBZ may favourably respond to slow substitution of sodium with physiologic saline. CBZ for secondary prophylaxis of PTE may cause hyponatraemia, cerebral edema, and deterioration of pre-existing TBI. Replacement of CBZ by levetiracetame may resolve the condition. CBZ should be used with caution for secondary prophylaxis of PTE in TBI.

Clinical manifestation of post-traumatic epilepsy features of its course / Монголын Анагаах Ухаан

Introduction. Traumatic brain injury (TBI) account for 20% of the symptomatic epilepsies in general population. Post traumatic epilepsy (PTE) may be presented with various clinical manifestations of seizure and clinical course of illness varies as well. The incidence of PTE varies with the time period after injury and the population age range under study, as well as the spectrum of severity of the inciting injuries ranges from 4% to 53%. In this study, we aimed to describe clinical characteristics and course of illness of patients with PTE.Materials and Methods. This hospital-based descriptive study was done 2012-2013 in Ulaanbaatar city. We retrospectively obtained number of patients with PTE reported in 2011-2012 from statistical reports of the National Health Center. In this study 109 patients with PTE, aged 16-72 were involved wrom which we collected detailed information on socio-demographic characteristics, history of illness, clinical manifestations including features of seizure and course of illness through pre-developed questionnaire. Medical examination was conducted after the interview to evaluate the seizures in accordance with semiological classification of epileptic seizures and the international classification International Leaque Against Epilepsy. Frequencies of variables including socio-demographic, clinical characteristics and clinical manifestations and, association between type of TBI and clinical manifestations were calculated. Correlation between diagnostic tests and clinical outcomes were also tested. Statistical analysis was conducted using SPSS 17.0 program. Ethical approval was obtained from the Ethical Committee of the School of Medicine, HSUM. Each participant had signed a consent form before involving in the study.Results. 81 (74.3%) participants of 109 were men and 28 (25.3%) were woman. Off our study participants, 98 (90%) were sufferng from generalized tonic clonic seizures. Off all participants, 43 (53.1%) males and 14 (50%) females presented moderate TBI. The mean duration of PTE is 9.6+-9.3 years, participants suffer from PTE 0-5 year. Of all, 19 (23.5%) males have a seizure once a week, 9(32.1%) female have seizure once a month. There were some differences in the forms of brain injury depending from gender; 57(70.4%) of males and 19(67.9%) of females had brain contusion. Only 5 (6.3%) of males had brain concussion, whereas for 6 (22.2%) females had this symptom. For males, intracranial hematoma accounted in 14 (17.7%), but for females in 2 (7.4%). Significant association was observed between clinical form of TBI and duration of loss of consciousness after the injury and injury severity (p<0.002). Of all, 21(19.3%) patients who had TBI were treated surgically. Its occurrence was positively correlated with early onset seizures (P<0.05). The frequency of seizure was not correlated with the structural brain abnormalities, but there was inverse association between frequency of seizure and duration of PTE (r= -0.32, p<0.001). As PTE continues longer the frequency of seizures decreases. Conclusion: Patients particularly surgically treated are suffer from PTE which is presented by generalized seizure. Patients with brain contusion, compression seem to be prone to post traumatic epilepsy. The course of PTE characterized long duration with high frequency of seizure, short time following by severe brain injury.

Clinical Characteristics of Post-traumatic Seizures in Children / 대한소아신경학회지

PURPOSE: Post-traumatic seizures (PTS) are well-recognized complications from head injuries and children are particularly more vulnerable to them. The aim of this study was to investigate the clinical characteristics of PTS in children and the findings of several diagnostic tools and to determine the role of prophylactic anticonvulsants. METHODS: We retrospectively reviewed the medical records of patient under 18 years of age who presented with seizures after traumatic brain injuries. Data analyzed included patient's demographics, clinical presentations, radiological and electroencephalographic findings, management and outcomes. RESULTS: Thirty one patients with PTS were included in the study and consisted of 13 males and 18 females. A mean age of the accident was 3.2 years (4 months-6.8 years) and a mean duration of follow-up was 26.0 months (12 months-54 months). Twenty one patients (67.7%) developed seizures within 24 hours after injury. Focal radiological findings were observed in 83.8% and described as subdural or epidural hematoma (25.8%), intraparenchymal hemorrhage (19.3%) and intracerebral parenchymal lesions (51.6%). Electroecephalographic findings included background abnormalities in 32.2% and interictal epileptiform discharges in 45.1%. All patients were treated with anticonvulsants for a certain period of time and a mean duration of treatment was 12.5 weeks (4-40 weeks). Eight patients (25.8%) developed subsequent seizures during follow-up period and 2 patients (6.5%) were diagnosed afterward with post-traumatic epilepsy. CONCLUSION: PTS generally take a benign clinical course, but subsequent seizures including epileptic seizures can occur in minor proportion. In these cases, radiological and electroencephalographic findings are helpful in prediction of clinical course of PTS.

Prognosis of patients with post-traumatic epilepsy at early time after traumatic diffuse axonal injury / 中华神经医学杂志

Objective To explore the prognosis of patients with post-traumatic epilepsy at early time after traumatic diffuse axonal injury(DAI).Methods One hundred and eighty-seven patients with DAI,admitted to our hospital from January 2000 to June 2011,were chosen; 26 DAI patients were complicated with post-traumatic epilepsy(PTE)at early time(within 2 weeks of injury),and the other 78 DAI patients without PTE were chosen as control group.Prognosis and activity of daily living(ADL)of these patients were evaluated with Glasgow Outcome Scale (GOS) and Barthel index.Results Significant differences on prognosis and ADL were noted between patients with and without PTE(P＜0.05); the prognosis of DAI patients attacked by PTE at early time was obviously worse than that of the ones who were not.DAI patients with PTE had low ADL than those patients without PTE.Conclusion Attacking by PTE at early time can obviously influence the prognosis of patients with DAI; especially for severe patients,the prognosis is obvious bad,and the mortality and disability rate increase significantly.

Risk Factors and Phenytoin Prophylaxis for Early Post-Traumatic Seizures among Patients with Traumatic Brain Injury

Background: Post-traumatic seizure is a well-known and serious complication of traumatic brain injury (TBI). The incidence and risk factors vary among study populations. Very little data have been published concerning this in the Malaysian population. The aim of this study was to ascertain the risk factors for the development of early post-traumatic seizures among patients with TBI. Methods: This was a prospective observational study, carried out in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, under the Department of Neurosciences. A total of 157 patients, from all age groups, who were diagnosed with TBI were enrolled from June 2007 to December 2007. They were followed-up for 12 months until death or their first post-traumatic seizure. Survival analysis with Kaplan–Meier curves and Cox proportional hazards regression was performed. Results: A total of 11 (7.0%) of the patients developed early post-traumatic seizures. The risk factors for early post-traumatic seizures were young age (P = 0.021, 95% CI 0.806 to 0.982) and intubated patients (P = 0.029, 95% CI 1.194 to 25.913). The incidence of early post-traumatic seizures in the local population was 7.0%. Conclusion: The incidence of early post-traumatic seizures in the local population of Kelantan and Terengganu is comparable to the incidences reported elsewhere. Younger as well as intubated patients were at a higher risk of developing this condition. It may be necessary to give antiepileptic prophylaxis because any seizure could adversely affect morbidity and mortality. However, the study showed that antiepileptic drug was not beneficial in preventing late post-traumatic seizures, but may have a role in preventing early seizures.

Control Investigation of Psychologic Status between Post-traumatic Epilepsy Patients and Their Spouses / 中国康复理论与实践

@#Objective To investigate and compare the special psychologic characteristics of the post-traumatic epilepsy patients and their spouses.Methods The complete clinical data of 244 patients and their spouses were retrospectively and constractively analyzed. There were two distinct groups because of the etiology: group A including 122 patients of post-traumatic epilepsy and their spouses, and group B including essential epilepsy. Symptom Checklist-90 (SCL-90), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) were used to evaluate the psychologic status of objects.Results All of the single-item score of SCL-90 were significantly higher than the China norm (P<0.01) in both groups, and the score in group A was higher than that in group B. But the characteristics of the abnormal data were diffierent in patient from in spouse. The scores of the post-traumatic patients were higher than that of the spouses in 3 items, and lower in 5 items. Specially the depression and anxiety emotion of the spouses were more obvious than the patients in group A (P<0.01).Conclusion Both the patient and spouse have the conspicuous psychosomatic disorder, and the appearance is diffierent from each other. The psychosomatic disorder of post-traumatic epilepsy patient and spouse is more conspicuous than the essential epilepsy.