Paroxysmal Cortical Slowing Predicts Posttraumatic Epilepsy After Severe Traumatic Brain Injury.

IF 3.1 3区医学 Q2 CLINICAL NEUROLOGY

Neurocritical Care Pub Date : 2025-05-20 DOI:10.1007/s12028-025-02282-5

Yonatan Serlin, Hamza Imtiaz, Mark A Maclean, Matthew W Pease, David O Okonkwo, Ava M Puccio, Shawn Eagle, James F Castellano, Sara K Inati, Alon Friedman

{"title":"Paroxysmal Cortical Slowing Predicts Posttraumatic Epilepsy After Severe Traumatic Brain Injury.","authors":"Yonatan Serlin, Hamza Imtiaz, Mark A Maclean, Matthew W Pease, David O Okonkwo, Ava M Puccio, Shawn Eagle, James F Castellano, Sara K Inati, Alon Friedman","doi":"10.1007/s12028-025-02282-5","DOIUrl":null,"url":null,"abstract":"Background: The objective of this study was to evaluate whether paroxysmal slow wave events (PSWEs) identified in early electroencephalography (EEG) predict posttraumatic epilepsy (PTE) and disability outcomes following severe traumatic brain injury (sTBI).Methods: A retrospective case-control study included 45 patients with sTBI (17 with PTE and 28 without PTE) matched by age and Glasgow coma scale. Clinical and EEG data were analyzed. Logistic regression and leave-one-out cross-validation (LOOCV) assessed PTE risk and disability. The area under the curve (AUC) measured accuracy.Results: Patients with PTE had longer time in PSWEs (P = 0.04) and lower median power frequency (MPF) of PSWEs (P = 0.02) on initial EEGs, along with increased time in PSWEs between initial and follow-up EEGs (P = 0.03). Lower MPF was associated with increased PTE risk (odds ratio 5.88; P = 0.04). Multivariate regression identified hemicraniectomy, time in PSWEs, and MPF as PTE predictors (AUC 0.87; P < 0.0001), maintaining strong LOOCV performance (AUC 0.83; P < 0.0001, accuracy 80%). Longer time in PSWEs was observed in patients with severe disability at the 3-, 6-, and 12-month follow-ups compared with moderate-to-good recovery (P = 0.012, 0.006, and 0.04, respectively).Conclusions: PSWEs predict PTE development and are more prevalent among patients with worse disability after sTBI. Quantitative PSWE analysis may guide preventive and therapeutic strategies for PTE.","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurocritical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12028-025-02282-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The objective of this study was to evaluate whether paroxysmal slow wave events (PSWEs) identified in early electroencephalography (EEG) predict posttraumatic epilepsy (PTE) and disability outcomes following severe traumatic brain injury (sTBI).

Methods: A retrospective case-control study included 45 patients with sTBI (17 with PTE and 28 without PTE) matched by age and Glasgow coma scale. Clinical and EEG data were analyzed. Logistic regression and leave-one-out cross-validation (LOOCV) assessed PTE risk and disability. The area under the curve (AUC) measured accuracy.

Results: Patients with PTE had longer time in PSWEs (P = 0.04) and lower median power frequency (MPF) of PSWEs (P = 0.02) on initial EEGs, along with increased time in PSWEs between initial and follow-up EEGs (P = 0.03). Lower MPF was associated with increased PTE risk (odds ratio 5.88; P = 0.04). Multivariate regression identified hemicraniectomy, time in PSWEs, and MPF as PTE predictors (AUC 0.87; P < 0.0001), maintaining strong LOOCV performance (AUC 0.83; P < 0.0001, accuracy 80%). Longer time in PSWEs was observed in patients with severe disability at the 3-, 6-, and 12-month follow-ups compared with moderate-to-good recovery (P = 0.012, 0.006, and 0.04, respectively).

Conclusions: PSWEs predict PTE development and are more prevalent among patients with worse disability after sTBI. Quantitative PSWE analysis may guide preventive and therapeutic strategies for PTE.

查看原文本刊更多论文

严重颅脑外伤后发作性皮质减慢预测创伤后癫痫。

背景：本研究的目的是评估在早期脑电图（EEG）中发现的阵发性慢波事件（PSWEs）是否能预测严重创伤性脑损伤（sTBI）后的创伤后癫痫（PTE）和残疾结局。方法：采用回顾性病例对照研究，纳入45例sTBI患者（17例伴PTE， 28例无PTE），按年龄和格拉斯哥昏迷评分进行匹配。分析临床和脑电图资料。逻辑回归和留一交叉验证（LOOCV）评估PTE风险和残疾。曲线下面积（AUC）测量精度。结果：PTE患者出现PSWEs的时间较长（P = 0.04），初始脑电图中位工频（MPF）较低（P = 0.02），初始脑电图与随访脑电图之间出现PSWEs的时间较长（P = 0.03）。较低的强积金与PTE风险增加相关(优势比5.88；p = 0.04)。多因素回归发现，半骨切除术、PSWEs时间和MPF是PTE的预测因子(AUC 0.87；结论：PSWEs预测PTE的发展，并且在sTBI后残疾更严重的患者中更为普遍。定量PSWE分析可以指导PTE的预防和治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.