Impact of seizures and their prophylaxis with antiepileptic drugs on rehabilitation course of patients with traumatic or hemorrhagic brain injury
ObjectiveTo determine whether, in patients undergoing rehabilitation after traumatic or hemorrhagic brain injury, seizures and the use of antiepileptic drugs (AEDs) negatively impact on functional outcome, and, in turn, whether prophylactic AED therapy can prevent the development of seizures.DesignO...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.1060008/full |
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| author | Valeria Pingue Chiara Mele Stefania Biscuola Antonio Nardone Antonio Nardone Antonio Nardone Sergio Bagnato Diego Franciotta |
| author_facet | Valeria Pingue Chiara Mele Stefania Biscuola Antonio Nardone Antonio Nardone Antonio Nardone Sergio Bagnato Diego Franciotta |
| author_sort | Valeria Pingue |
| collection | DOAJ |
| description | ObjectiveTo determine whether, in patients undergoing rehabilitation after traumatic or hemorrhagic brain injury, seizures and the use of antiepileptic drugs (AEDs) negatively impact on functional outcome, and, in turn, whether prophylactic AED therapy can prevent the development of seizures.DesignObservational retrospective study.SettingHighly specialized inpatient neurorehabilitation clinic.ParticipantsPatients with traumatic brain injury (TBI), or hemorrhagic stroke (HS) consecutively admitted to our neurorehabilitation unit between January 1, 2009, and December 31, 2018.Main measures and variablesPatients' demographic data, neurological status (Glasgow Coma Scale), and rehabilitation outcome (Functional Independence Measure scale), both assessed on admission and on discharge, associated neurosurgical procedures (craniectomy, or cranioplasty), AED use, early or late seizures occurrence, and death during hospitalization.ResultsOf 740 patients, 162 (21.9%) had seizures, and prophylactic AEDs were started in 192 (25.9%). Multivariate logistic regression identified severity of brain injury as a risk factor for acute symptomatic seizures (ASS) in HS (OR = 1.800, 95%CI = 1.133–1.859, p = 0.013), and for unprovoked seizures (US) in TBI (OR = 1.679, 95%CI = 1.062–2.655, p = 0.027). Prophylaxis with AEDs reduced ASS frequency, but, if protracted for months, was associated with US occurrence (HS, p < 0.0001; TBI, p = 0.0002; vs. untreated patients). Presence of US (β = −0.12; p < 0.0001) and prophylaxis with AEDs (β = −0.09; p = 0.002), were associated with poor functional outcome, regardless of age, severity of brain insult, and HS vs. TBI subtype.ConclusionsSeverity of brain injury and occurrence of seizures during neurorehabilitation are the main driver of poor outcome in both HS and TBI. The possible detrimental role on the epileptogenic and functional outcome played by seizures prophylaxis with AEDs, nonetheless useful to prevent ASS if administered over the first week after the brain injury, warrants further investigation. |
| first_indexed | 2024-04-13T21:50:33Z |
| format | Article |
| id | doaj.art-f1d5f1b2beee48e29c7bdf4a81a28274 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-13T21:50:33Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-f1d5f1b2beee48e29c7bdf4a81a282742022-12-22T02:28:26ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-11-011310.3389/fneur.2022.10600081060008Impact of seizures and their prophylaxis with antiepileptic drugs on rehabilitation course of patients with traumatic or hemorrhagic brain injuryValeria Pingue0Chiara Mele1Stefania Biscuola2Antonio Nardone3Antonio Nardone4Antonio Nardone5Sergio Bagnato6Diego Franciotta7Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, ItalyDepartment of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, ItalyDepartment of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, ItalyNeurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, ItalyDepartment of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, ItalyNeurorehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Montescano, PV, ItalyUnit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, PA, ItalyIRCCS Mondino Foundation, Pavia, ItalyObjectiveTo determine whether, in patients undergoing rehabilitation after traumatic or hemorrhagic brain injury, seizures and the use of antiepileptic drugs (AEDs) negatively impact on functional outcome, and, in turn, whether prophylactic AED therapy can prevent the development of seizures.DesignObservational retrospective study.SettingHighly specialized inpatient neurorehabilitation clinic.ParticipantsPatients with traumatic brain injury (TBI), or hemorrhagic stroke (HS) consecutively admitted to our neurorehabilitation unit between January 1, 2009, and December 31, 2018.Main measures and variablesPatients' demographic data, neurological status (Glasgow Coma Scale), and rehabilitation outcome (Functional Independence Measure scale), both assessed on admission and on discharge, associated neurosurgical procedures (craniectomy, or cranioplasty), AED use, early or late seizures occurrence, and death during hospitalization.ResultsOf 740 patients, 162 (21.9%) had seizures, and prophylactic AEDs were started in 192 (25.9%). Multivariate logistic regression identified severity of brain injury as a risk factor for acute symptomatic seizures (ASS) in HS (OR = 1.800, 95%CI = 1.133–1.859, p = 0.013), and for unprovoked seizures (US) in TBI (OR = 1.679, 95%CI = 1.062–2.655, p = 0.027). Prophylaxis with AEDs reduced ASS frequency, but, if protracted for months, was associated with US occurrence (HS, p < 0.0001; TBI, p = 0.0002; vs. untreated patients). Presence of US (β = −0.12; p < 0.0001) and prophylaxis with AEDs (β = −0.09; p = 0.002), were associated with poor functional outcome, regardless of age, severity of brain insult, and HS vs. TBI subtype.ConclusionsSeverity of brain injury and occurrence of seizures during neurorehabilitation are the main driver of poor outcome in both HS and TBI. The possible detrimental role on the epileptogenic and functional outcome played by seizures prophylaxis with AEDs, nonetheless useful to prevent ASS if administered over the first week after the brain injury, warrants further investigation.https://www.frontiersin.org/articles/10.3389/fneur.2022.1060008/fullneurorehabilitationtraumatic brain injuryhemorrhagic strokeantiepileptic drugsepilepsy |
| spellingShingle | Valeria Pingue Chiara Mele Stefania Biscuola Antonio Nardone Antonio Nardone Antonio Nardone Sergio Bagnato Diego Franciotta Impact of seizures and their prophylaxis with antiepileptic drugs on rehabilitation course of patients with traumatic or hemorrhagic brain injury Frontiers in Neurology neurorehabilitation traumatic brain injury hemorrhagic stroke antiepileptic drugs epilepsy |
| title | Impact of seizures and their prophylaxis with antiepileptic drugs on rehabilitation course of patients with traumatic or hemorrhagic brain injury |
| title_full | Impact of seizures and their prophylaxis with antiepileptic drugs on rehabilitation course of patients with traumatic or hemorrhagic brain injury |
| title_fullStr | Impact of seizures and their prophylaxis with antiepileptic drugs on rehabilitation course of patients with traumatic or hemorrhagic brain injury |
| title_full_unstemmed | Impact of seizures and their prophylaxis with antiepileptic drugs on rehabilitation course of patients with traumatic or hemorrhagic brain injury |
| title_short | Impact of seizures and their prophylaxis with antiepileptic drugs on rehabilitation course of patients with traumatic or hemorrhagic brain injury |
| title_sort | impact of seizures and their prophylaxis with antiepileptic drugs on rehabilitation course of patients with traumatic or hemorrhagic brain injury |
| topic | neurorehabilitation traumatic brain injury hemorrhagic stroke antiepileptic drugs epilepsy |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.1060008/full |
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