Prognostic factors in the persistence of posttraumatic epilepsy after penetrating head injuries sustained in war

Clinical article

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Object

The goal of this paper was to investigate the long-term outcome and the possible prognostic factors that might have influenced the persistence of posttraumatic epilepsy after penetrating head injuries sustained during the Iraq–Iran war (1980–1988).

Methods

In this retrospective study, the authors evaluated 189 patients who sustained penetrating head injury and suffered posttraumatic epilepsy during the Iraq–Iran war (mean 18.6 ± 4.7 years after injury). The probabilities of persistent seizures (seizure occurrence in the past 2 years) in different periods after injury were estimated using the Kaplan-Meier method. The possible prognostic factors (patients and injury characteristics, clinical findings, and seizure characteristics) were studied using log-rank and Cox regression analysis.

Results

The probability of persistent seizures was 86.4% after 16 years and 74.7% after 21 years. In patients with < 3 pieces of shrapnel or no sphincter disturbances during seizure attacks, the probability of being seizure free after these 16 and 21 years was significantly higher.

Conclusions

Early seizures, prophylactic antiepileptics drugs, and surgical intervention did not significantly affect long-term outcome in regard to persistence of seizures.

Abbreviations used in this paper: EEG = electroencephalography; PTE = posttraumatic epilepsy.

Article Information

Address correspondence to: Behzad Eftekhar, M.D., M.P.H., Sina Trauma Research Center, Sina Hospital, Tehran, Iran. email: Beftekhar@yahoo.com or eftekhar@sina.tums.ac.ir.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Kaplan-Meier graph showing the probability of persistent seizures in the entire cohort of patients.

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    Kaplan-Meier graph comparing probabilities of persistent seizures in patients with and without sphincter disturbances.

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    Kaplan-Meier graph comparing probabilities of persistent seizures in patients with < 3 pieces of shrapnel and those with ≥ 3 pieces.

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