创伤性脑损伤患者术后癫痫发作的预测因素：一项单中心回顾性研究

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-08-20 DOI:10.1016/j.clineuro.2025.109116

Daniel Sconzo , Aryan Wadhwa , Kaasinath Balagurunath , Megan Berube , Zachary Wetsel , Naveen Arunachalam Sakthiyendran , Anirudh Penumaka , Alejandro Enriquez-Marulanda , Kristine Ravina , Emanuela Binello

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引用次数: 0

摘要

简介/目的癫痫是创伤性脑损伤（TBI）手术治疗后常见的并发症。然而，对于术前预测它们的因素知之甚少。本研究旨在探讨影响TBI术后癫痫发作的术前因素。方法回顾性分析2012 - 2021年所有手术TBI患者。仅接受医疗管理的TBI患者被排除在外。术后癫痫发作的存在是根据TBI手术后癫痫发作的医疗记录来确定的。在tbi前有癫痫发作记录的个体被排除在分析之外。进行单因素比较和多因素logistic回归。结果本研究共纳入200例受试者。46例患者（24.96 %）在手术后一周内至少有一次记录在案的术后癫痫发作。其中，97.5% %使用左乙拉西坦预防覆盖。与术后癫痫发作相关的因素包括年龄≥ 60岁（p = .045）和吸烟史（p = .048）。在损伤包括硬膜下血肿的个体中，有显著的趋势（p = ）。086)，以及有糖尿病史的人（p = .053）。根据首发时的初始GCS，没有差异（p = ）。54)， EDH的存在（p = ）。83), IPH (p = 。75), SAH/IVH (p = 。51)，中线移位(p = 。114)，程序类型(p = 。52)（开颅术或开颅术）。在控制年龄、糖尿病和当前吸烟史的多因素分析中，SDH存在（OR 4.39 CI95 % 1.33 - 14.50）和既往吸烟状况（OR 3.49 CI95 % 1.31 - 9.16）是显著的危险因素。术后7天以上癫痫发作的患者既往吸烟仍有显著意义（OR 4.56; CI 95 % 1.13-18.27）。结论在TBI术后患者中，既往吸烟者和SDH的存在显著增加了癫痫发作的风险，即使在服用预防性asm时也是如此。在处理术后TBI患者时应考虑这些因素。

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Predictors of seizures in postoperative traumatic brain injury patients: A single center retrospective study

Introduction/objectives

Seizures are common postoperative complications for patients who have undergone surgical management for traumatic brain injury (TBI). However, little is known regarding preoperative factors that predict them. This study aims to describe preoperative factors that influence the occurrence of seizures after surgery for TBI.

Methods

A retrospective study of all operative TBI patients between 2012 and 2021 was performed. Individuals with TBI that received medical management only were excluded. The presence of postoperative seizures was determined according to documentation in the medical record of seizures after the date of surgery for TBI. Individuals who had documented seizures pre-TBI were excluded from the analysis. Univariate comparisons and multivariate logistic regression were performed.

Results

200 individuals were included in this study. Forty-six individuals (24.96 %) experienced at least one documented postoperative seizure within one week of surgery. Of those, 97.5 % were on Levetiracetam prophylactic coverage. Factors associated with postoperative seizures included age ≥ 60 years (p = .045) and smoking history (p = .048). A trend towards significance was seen in individuals whose injuries included subdural hematomas (p = .086), as well as those with a history of diabetes (p = .053). There were no differences according to initial GCS at presentation (p = .54), presence of EDH (p = .83), IPH (p = .75), SAH/IVH (p = .51), midline shift (p = .114), procedure type (p = .52) (craniotomy or craniectomy). SDH presence (OR 4.39 CI95 % 1.33 – 14.50) and former smoking status (OR 3.49 CI95 % 1.31 – 9.16) were significant risk factors on multivariate analysis when controlling for age, diabetes, and current smoking history. Former smoking remained significant in patients experiencing siezures greater than 7 days post-surgery as well (OR 4.56; CI 95 % 1.13–18.27).

Conclusion

In postoperative TBI patients, former smokers and the presence of SDH significantly increase the risk of experiencing seizures even while on prophylactic ASMs. These factors should be considered when managing postoperative TBI patients.

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.