Posttraumatic seizures are a common complication of traumatic brain injury. Posttraumatic epilepsy accounts for 20% of symptomatic epilepsy in the general population and 5% of all epilepsy. Early posttraumatic seizures occur in more than 20% of patients in the intensive care unit and are associated with secondary brain injury and worse patient outcomes. Most posttraumatic seizures are nonconvulsive and therefore continuous electroencephalography monitoring should be the standard of care for patients with moderate or severe brain injury. The literature shows that posttraumatic seizures result in secondary brain injury caused by increased intracranial pressure, cerebral edema and metabolic crisis.
Key points
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As commonly defined, early posttraumatic seizures occur within 7 days of injury, whereas late posttraumatic seizures occur more than 7 days after injury and define posttraumatic epilepsy (PTE).
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Early posttraumatic seizures are not benign and are associated with increased intracranial pressure, metabolic crisis, brain atrophy, and worse outcomes.
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The use of continuous electroencephalography in patients with moderate or severe traumatic brain injury should be the standard of care because of the high incidence of seizures and resultant secondary brain injury in this population.
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Antiepileptic drug prophylaxis is indicated within 7 days of injury to decrease the incidence of early posttraumatic seizures, but does not prevent PTE.
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The risk of developing PTE is strongly related to the severity of head injury and is highest in the first 2 years after traumatic brain injury.
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