CINCINNATI — For hospitalized patients with moderate to severe traumatic brain injuries, more than half have seizures and abnormal periodic or rhythmic patterns observed on continuous electroencephalography monitoring (cEEG).
A study involving University of Cincinnati and Walter Reed Army Institute of Research, Brain Trauma, Neuroprotection and Neurorestoration Branch researchers sought to determine the impact of seizures and abnormal periodic or rhythmic patterns on cognitive outcome three months following moderate to severe TBI. Results were published in Neurocritical Care.1
To do that, the study team performed a post hoc analysis of the multicenter randomized controlled phase 2 INTREPID2566 clinical trial conducted from 2010 to 2016 across 20 United States Level I trauma centers. Included were 142 patients, median age of 32, with nonpenetrating TBI and post-resuscitation Glasgow Coma Scale scores 4-12. The participants had a mean global cognition score of more than 81.
With bedside cEEG begun protocol on admission to intensive care, as required by protocol, researchers were able to quantify ictal-interictal continuum (IIC) patterns, including seizures. The primary outcome was defined as summary global cognition score at three months following injury.
Results indicated that nearly one-third of the patients were considered to have poor functional outcome. Most, 63%, of patients underwent cEEG, and 15% of those had severe IIC patterns.
“The quantitative burden of IIC patterns correlated inversely with the global cognition score (r = – 0.57; p = 0.04). In multiple variable analysis, the log-transformed burden of severe IIC patterns was independently associated with the global cognition score after controlling for demographics, premorbid estimated intelligence, injury severity, sedatives, and antiepileptic drugs (odds ratio 0.73, 95% confidence interval 0.60-0.88; p = 0.002),” the researchers wrote.
The study found that “the burden of seizures and abnormal periodic or rhythmic patterns was independently associated with worse cognition at three months following TBI. Their impact on longer-term cognitive endpoints and the potential benefits of seizure detection and treatment in this population warrant prospective study.”
- Foreman B, Lee H, Mizrahi MA, Hartings JA, Ngwenya LB, Privitera M, Tortella FC, Zhang N, Kramer JH. Seizures and Cognitive Outcome After Traumatic Brain Injury: A Post Hoc Analysis. Neurocrit Care. 2021 Jul 7. doi: 10.1007/s12028-021-01267-4. Epub ahead of print. PMID: 34232458.