What are posttraumatic seizures (PTS) in patients with traumatic brain injury (TBI)?

Updated: Feb 01, 2018
  • Author: Percival H Pangilinan, Jr, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Posttraumatic seizures (PTS) frequently occur after moderate or severe TBI. Seizures are usually general or partial, and absence seizures are uncommon. Seizures are classified according to the time elapsed after the initial injury: Immediate seizures occur in the first 24 hours. Early seizures occur in the first 2-7 days, and late seizures occur after 7 days.

The incidence of late PTS is in the range of 5-18.9%. Risk factors include chronic alcoholism, older age at the time of injury, and a history of seizure disorder. Approximately one half to two thirds of patients with these risk factors develop late PTS within the first year after injury. [27] If a patient with TBI has 1 PTS, his or her likelihood of having another is approximately 50%. [28]

A study by Majidi et al, using information from the National Trauma Data Bank, indicated that the rate of early, in-hospital seizures among patients with TBI is 0.4%, with seizure patients more likely to have African-American ethnicity, moderate TBI, a history of alcohol dependence, fall as the mechanism of injury, and subdural hematoma. The study also suggested that TBI patients with in-hospital seizures have higher rates of complications such as pneumonia, acute respiratory distress syndrome, acute kidney injury, and increased intracranial pressure. Moreover, seizure patients in the study tended to have worse hospital outcomes, with a higher rate of discharge to nursing facilities. [29]

Temkin showed that prophylactic use of phenytoin is effective during the first week after a TBI. [30] However, the author recommended discontinuation after 1 week if no seizures develop because of its lack of effect in preventing late PTS and because of possible cognitive adverse effects.

Although phenytoin maybe effective in preventing seizures in the first week after a TBI, at least 50% of patients with TBI have late seizure activity for which phenytoin may not be effective.

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