Mechanism of action of oxidative stress in severe traumatic brain injury and its complications: recent progress / 中华创伤杂志

Severe traumatic brain injury (sTBI) is characterized by critical condition, high lethality and poor prognosis. Its development and progression will lead to the damage and death of a large number of nerve cells, eventually causing a series of serious complications. The current treatments of sTBI and its complications are not optimistic due to problems such as unclear mechanism of action, challenges in treatment, and lack of effective prevention strategies. In recent years, more research evidences have shown that oxidative stress plays an important role in the development and progression of sTBI and its related complications. Therefore, it is of great significance to clarify the relationship of oxidative stress with sTBI and its complications and to understand the way of oxidative stress participating in the development and progression of sTBI. However, relevant researches are scattered and there lacks comprehensive and systematic summaries of oxidative stress participating in sTBI and its related complications. To this end, the authors reviewed the progress of the mechanism by which oxidative stress involves in sTBI and its complications, hoping to provide references for the research, treatment and prevention of sTBI.

Indication and early medicational administration of patients with traumatic brain injury for admission to neurological intensive care unit / 中华创伤杂志

Objective:To analyze the indication and status of early use of analgesic, sedative and antiepileptic drugs of patients with traumatic brain injury (TBI) admitted to the neurological intensive care unit (NICU).Methods:A questionnaire covering hospital basic characteristics, prehospital and emergency care, inpatient treatment, neurocritical care and rehabilitation were used to survey NICU of 37 hospitals in 18 municipalities or provinces from the Chinese registry of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) by Web or Email. The indications for admission to the NICU, categories and frequency of early use of analgesic and sedative drugs, and categories, frequency and indications of early use of antiepileptic drugs were analyzed.Results:Glasgow coma scale (GCS)≤8 points in patients with TBI and post-operation of TBI were the main indications for admission in 30 NICU (81.1%) and 24 NICU (64.9%), respectively. When admitting patients with a GCS of 9-12 points or 13-15 points, most NICU gave more considerations to the combined other risk factors. In terms of the early use of analgesics and sedatives, fentanyl was routinely used for analgesia (i.e., use frequency for 70%-100%) in 13 NICU (35.1%), and midazolam and alpha-2 agonists were routinely used for sedation in 24 NICU (64.9%) and 18 NICU (48.6%), respectively. Regarding the early use of antiepileptic drugs, sodium valproate was routinely used in 35 NICU (94.6%). Moreover, seizures within 2 hours after injury, penetrating TBI and cortical contusion were indications for routine application of antiepileptic drugs in 35 NICU (94.6%), 21 NICU (56.8%) and 20 NICU (54.1%), respectively.Conclusions:Severe TBI and post-operation of TBI are the main indications for admission to the NICU, while the combination of other risk factors will be considered when admitting patients with moderate or mild TBI. For TBI patients admitted to NICU, fentanyl, midazolam and sodium valproate are the most commonly used analgesic, sedative, and antiepileptic drugs in the early stage. Seizures within 2 hours after injury, penetrating TBI and cortical contusion are the main indications for antiepileptic drug use.

Progress in Research on Biomarkers of Post-Traumatic Epilepsy / 法医学杂志

Post traumatic epilepsy （PTE） is a serious complication of traumatic brain injury and a difficult problem in forensic justice practice. In recent years, many biomarkers have been applied to the diagnosis, treatment and prognosis of injuries and diseases. There have been many studies on the biomarkers of PTE in the field of epilepsy. This paper reviews the progress in research on biomarkers of PTE in recent years in order to provide reference for the forensic identification of PTE.

Clinical analysis on risk factors and prognosis of early post-traumatic epilepsy / Análise clínica de fatores de risco e prognóstico da epilepsia pós-traumática precoce

ABSTRACT Objective To analyze the risk factors and prognosis related to early post-traumatic epilepsy (EPTE). Methods One hundred and eighty-six patients with traumatic brain injury were enrolled. Their full clinical data were collected. Single factor analysis and logistic regression analysis of risk factors related to EPTE were performed. The prognosis of patients was determined. Results Single factor analysis showed that there were significant differences of age (p = 0.011), epilepsy history (p < 0.001), injury site (p = 0.004), injury type (p < 0.001) and injury degree (p < 0.001) between the EPTE group (40 patients) and non-EPTE group (146 patients). Logistic regression analysis showed that the injury site, injury type and injury degree were the main risk factors for EPTE. The odds ratio values of injury site, injury type and injury degree were 1.977 (1.473-2.679), 2.096 (1.543-2.842) and 2.376 (1.864-3.609), respectively. The logistic regression equation was P = Exp (-1.473 + 0.698 × injury site + 0.717 × injury type + 0.935 × injury degree). The sensitivity and specificity of injury site, injury type and injury degree for predicting EPTE were 79.2% and 80.5%, 78.9% and 85.7% and 84.2% and 81.0%, respectively. The analysis of prognosis showed that the Glasgow Outcome Scale/Activity of Daily Living Scale scores in the EPTE group were significantly lower than those in non-EPTE group (p < 0.05). Conclusions Injury site, injury type and injury degree are the main risk factors for EPTE. The prognosis of patients with traumatic brain injury can be affected by EPTE.

RESUMO Objetivo Analisar os fatores de risco e prognóstico relacionados à epilepsia pós-traumática precoce (EPTE). Métodos Cento e oitenta e seis pacientes com lesão cerebral traumática foram incluídos. Seus dados clínicos completos foram coletados. A análise fatorial única e a análise de regressão logística dos fatores de risco relacionados à EPTE foram realizadas. O prognóstico dos pacientes foi observado. Resultados A análise fatorial única mostrou que houve diferenças significativas de idade (p = 0,011), história de epilepsia (p < 0,001), local da lesão (p = 0,004), tipo de lesão (p < 0,001) e grau de lesão (p < 0,001) entre o grupo EPTE (40 casos) e o grupo não-EPTE (146 casos), respectivamente. A análise de regressão logística mostrou que o local da lesão, tipo de lesão e grau de lesão foram os principais fatores de risco para EPTE. Os valores de razões de chance do local da lesão, tipo de lesão e grau de lesão foram 1.977 (1.473-2.679), 2.096 (1.543-2.842) e 2.376 (1.864-3.609), respectivamente. A equação de regressão logística foi P = Exp (-1,473 + 0,698 × local de lesão + 0,717 × tipo de lesão + 0,935 × grau de lesão). A sensibilidade e especificidade do local da lesão, tipo de lesão e grau de lesão para a predição da EPTE foram de 79,2% e 80,5%, 78,9% e 85,7% e 84,2% e 81,0%, respectivamente. A análise do prognóstico mostrou que o escore da Escala de Desfechos de Glasgow / Atividade de Vida Diária no grupo EPTE foi significativamente menor do que no grupo não-EPTE (P <0,05). Conclusões O local da lesão, tipo de lesão e grau de lesão são os principais fatores de risco para EPTE. A EPTE pode afetar o prognóstico de pacientes com lesão cerebral traumática.

Retrospective Analysis of Forensic Appraisal of Post-traumatic Epilepsy in 30 Cases / 法医学杂志

Objective To summarize the general characteristics and identification considerations of appraisal of post-traumatic epilepsy （PTE） in forensic clinical expertise. Methods Descriptive statistics were made on the general situations （age and sex）, injury sites, PTE grading, clinical manifestations and blood drug concentrations of 30 cases of PTE. Chi-square test was performed on the differences of sex composition, age group incidences, injury sites, clinical manifestations and PTE grading. Fisher's exact probability method was used to test the differences in clinical manifestations and PTE grading of each site and the differences in PTE grading of different clinical manifestations. Results PTE occurred more frequently among 21 to 40 year olds, more in males than in females, and more frequently in the temporal lobe and frontal lobe. The clinical manifestations were mostly partial seizures and the PTE grading was mostly mild PTE. There were no statistical significance in the differences in distribution of clinical manifestations and PTE grading of injury sites （P>0.05）. The difference in the PTE grading of different clinical manifestations had no statistical significance （P>0.05）. The blood drug concentration of the three identified people did not reach the effective concentration, which affected the final identification opinion. Conclusion In the identification of PTE, in addition to strictly grasping the necessary factors of identification, such as the history of craniocerebral trauma, and epileptic seizures, it is also suggested that attention should be paid to the detection of blood drug concentration. Overall analysis and comprehensive evaluation should be made.

The etiology analysis of 665 hospitalized patients with epilepsy in Southern Sichuan / 中华神经科杂志

Objective To investigate the distribution of the general etiology of hospitalized patients with epilepsy in Southwest China and the etiological distribution of epilepsy patients of different ages.Methods The complete medical records of hospitalized patients with epilepsy diagnosed in our hospital from August 2014 to July 2017 were collected,the overall cause of the disease was classified,and the etiology distribution of different age groups was analyzed.Results A total of 665 eligible patients were enrolled.The overall etiology of epilepsy was structural (398/665,59.8％),infectious (122/665,18.3％) and metabolic (12/665,1.8％).The etiological and genetic causes were rare.Childhood and adolescent epilepsies were mainly due to unknown,viral infection,intracranial vascular malformations and cortical development disorders.As for etiology in adults,traumatic brain injury accounted for 18.0％ (68/380),cerebral hemorrhage accounted for 18.7％ (71/380),and brain tumors accounted for 17.1％ (65/380).Elderly patients with epilepsy accounted for 59.6％ (106/178) of stroke and other cerebrovascular diseases,followed by traumatic brain injury (17/178,9.6％) and neoplastic disease (17/178,9.6％).Conclusions The etiology of hospitalized epilepsy patients in Southern Sichuan is mainly structural lesions.And cerebrovascular disease,intracranial infection,brain trauma and tumor are the most common etiologies,but there are different etiologies at different ages.

Progress on Post Traumatic Epilepsy and Its Forensic Evaluation / 法医学杂志

Post traumatic epilepsy （PTE） refers to the epileptic seizures after traumatic brain injury. Organic damage can be found by imaging examination, and abnormal electroencephalogram can be detected via electroencephalogram examination which has the similar location of the brain injury. PTE has the characteristics of low incidence, absence of case reports, and easy to exaggerate the state of illness, which add difficulties to the forensic identification. This paper reviews the status of epidemiology, pathogenesis, clinical treatment and forensic identification for PTE.

Localization and microsurgical management of epileptogenic nidus of traumatic epilepsy / 中华创伤杂志

Objective To investigate the localization and surgical outcome of epileptogenic nidus of post-traumatic epilepsy. Methods A retrospective analysis was performed on clinical data of 62 patients with post-traumatic epilepsy treated microsurgicallly from November 2005 to May 2009. There were 48 males and 14 females, at age range from 11 to 48 years old (average 28.8 years old). The epileptogenic nidus in 59 patients was localized based on clinical manifestations, visual electroencephalography (V-EEC) imaging and electrophysiological findings and that in three patients localized by implanted intracranial electrodes. Under electrocorticogram (ECoG) monitoring, we resected cerebral malacia in 36 patients, removed both malacia and epileptogenic nidus in 15, and partially resected cerebral malacia combined with cortex thermocoagulation in 11. Results The follow-up for 6-33 months showed that there were 32 patients at grade Ⅰ , 17 at grade Ⅱ , nine at grade Ⅲ and four at grade Ⅳ according to Engel classification system. Conclusion V-EEG is an important method for pre-operative localization of epileptogenic nidus of post-traumatic epilepsy. Microsurgical management can attain favorable outcome under ECoG monitoring.

Surgcial treatment of post-traumatic epilepsy / 中华创伤杂志

Objective To explore the localization of epileptogenic focus and select the appropriate surgical procedures for post-traumatic epilepsy. Methods The clinical data of 21 patients with post-traumatic epilepsy were studied retrospectively. Epileptogenic focus was located by comprehensively analyzing data of electro-neurophysiology, neurological imaging and clinical manifestation. Surgical procedures were performed in all patients, including resection of lesion and peripheral cortex in 12 patients, epileptogenie focus resection plus low power bipolar coagulation in five, anterior temporal iobectomy plus amygdalohippocampectomy in three and corpus callosotomy in one. Results All patients were followed up from 6 months to 3 years, which showed satisfactory outcome in eight patients, marked improvement in six, improvement in five and slight improvement in two. The total effective rate was 90%. Conclusions Surgical procedure is important for intractable post-traumatic epilepsy. The good efficacy depends on precise localization of epileptogenic focus and combined application of various surgical procedures.

Location of epileptogenic focus and selection of appropriate surgical methods in treatment of post-traumatic epilepsy / 中国医师杂志

Objective To evaluate the efficacy of combined various surgical procedures for the treatment of post-traumatic epilepsy.Methods According to the preoperative primary location of epileptogenic focus and the monitoring results of intraoperative electrocorticography and depth electrodes,21 seizure patients were treated with various surgical procedures: 7 cases with epileptogenic focus resection,8 cases with epileptogenic focus resection combined with multiple subpial transection(MST),4 cases with anterior temporal lobectomy combined with amygdalo-hippocampotomy,1 case with selective amygdalo-hippocampotomy under neuronavigation,and 1 case with anterior callosotomy combined with MST and bipolar coagulation on funtional cortexes. Results All the patients were followed up from 3 months to 10 years postoperatively,and the surgical outcomes were such as the followings: satisfactory outcome in 9 cases(42.9%),marked improvement in 7 cases(33.3%),improvement in 3 cases(14.3%),slight improvement in 1 case(4.8%) and no improvement in 1case(4.8%).There was no died cases caused by the surgical procedures.Eight patients had temporary dysfunction after operation,but all recovered in four weeks after surgery.Conclusion The combined various surgical procedures are effective and safe for the treatment of post-traumatic epilepsy.