Abstract Details

Title The Relationship between Seizures, Ictal-Interictal EEG Activity, Clinical Outcome, and Dynamic Neurologic Changes following Traumatic Brain Injury

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-024

Objective

Seizures and IIC abnormalities (IICA) after traumatic brain injury (TBI) are associated with poor outcome. We examined structural and dynamic features to examine the pathophysiology mediating this relationship.

Background

Seizures and IICA are common after TBI.

Design/Methods

We retrospectively studied TBI patients undergoing continuous EEG (2013-2017). Electrographic seizures and IICA (lateralized rhythmic delta or periodic discharges were evaluated for association with clinicoradiologic features (APACHE-II score, contusional, subdural, epidural, subarachnoid compartment hematomas), poor outcome (discharge GOSE 1-2, and dynamic changes in GCS measurements at admission and during EEG.

Results

108 TBI patients met criteria; 39 (36.1%) demonstrated seizures or IICA. In univariate analysis, the presence of seizure on cEEG was associated with worst 24-hour GCS, 24-hour GCS deterioration, and clinical seizure at admission. On logistic regression, only worst GCS (OR 1.19, CI 1.08-1.44, p= 0.02) and clinical seizures at admission (OR 11.42, CI 2.73-53.47, p=0.001) were independently associated with electrographic seizures. Excluding patients with seizures, the presence of IICA was associated with age, gender, worst 24-hour GCS and SDH. Age, GCS and presence of SDH were no longer significant in multivariate analysis. Poor outcome was independently associated on logistic regression with APACHE-II score (OR 1.14, CI 1.04-1.26, p=0.004) and GCS deterioration during EEG monitoring (OR 0.69, CI 0.56-0.85, p=0.001). GCS deterioration during EEG was greater when the following were present vs. absent: non-seizure IICA (mean change -1.4 vs. +0.80, p=0.001), and seizures (mean change -1.2 vs. +0.33, p=0.01). GCS deterioration was not different for the presence vs. absence of burst-suppression (mean change -0.40 vs. -0.27, p=0.45) or generalized rhythmic delta activity (mean change -0.33 vs. +0.11, p=0.27).

Conclusions

TBI patients with GCS deterioration are at highest risk for seizures after TBI. The association of seizures and IICA with neurologic deterioration appears to be one factor mediating their association with poor outcome.

Authors/Disclosures
Muhammad Muzzammil Edhi, MBBS (Brown University/ Rhode Island Hospital) PRESENTER	Dr. Edhi has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Hassan Aboul Nour, MD	Dr. Aboul Nour has nothing to disclose.
Farrukh Javed, MD	Dr. Javed has nothing to disclose.
Elahe Bordbar, MD	Dr. Bordbar has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Jin Jing	No disclosure on file
	No disclosure on file
M. B. Westover, MD, PhD (MGH)	Dr. Westover has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Beacon Biosignals. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities.
Sahar Zafar, MD	Dr. Zafar has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Zafar has received research support from NIH. Dr. Zafar has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker for a lecture with Marinus.
Eric Rosenthal, MD (Massachusetts General Hospital)	Dr. Rosenthal has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma, Inc. . Dr. Rosenthal has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceribell, Inc. . The institution of Dr. Rosenthal has received research support from Sage Therapeutics. Dr. Rosenthal has received intellectual property interests from a discovery or technology relating to health care.

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