Key Points

  • There are several patient and injury characteristics that increase the likelihood for the development of late post-traumatic seizures. Some important patient characteristics include: increasing age, premorbid alcohol abuse, and family history. 
     
  • In terms of injury characteristics, markers of increasing injury severity such as penetrating injuries and depressed skull fracture increase the risk.
     
  • Seizures occurring within the first week post injury (early seizures) increase the risk of late post-traumatic seizures.
     
  • The risk of epilepsy is highest within the first two years following brain trauma.
     
  • As brain injury severity increases, the period of time for which a survivor is at risk of developing post-traumatic seizures also increases.
     
  • Individuals who develop seizures after the first week following TBI have an increased chance of experiencing seizure recurrence; seizures occurring immediately following TBI do not increase the risk of recurrence.
     
  • The risk associated with a single late post-traumatic seizure is minimal and no different than that seen after any seizure.
     
  • Following TBI, seizure recurrence can be a significant source of morbidity. Severe and widespread seizure recurrence during the first six days post TBI can be associated with permanent impairments in functional recovery. Those patients with a higher seizure frequency and severity are at increased risk of complications.
     
  • Status epilepticus is a rare complication of post-traumatic seizure.
     
  • Mortality rates are higher in those patients with TBI diagnosed with post-traumatic seizures, compared to those without seizures.
     
  • Levetiracetam is as effective as phenytoin in treating and preventing seizures in individuals in the intensive care unit post ABI
     
  • Anticonvulsants provided immediately post ABI only reduce the occurrence of seizures within the first week.
     
  • Anticonvulsants provided shortly post ABI do not reduce late seizures.
     
  • Anticonvulsants have negative consequences on motor tasks.
     
  • Intramuscular midazolam may be effective for acute seizure cessation.
  • Phenobarbital has not been shown to be effective in reducing the risk of late seizure development post ABI.
     
  • Glucocorticoid administration increases the risk of developing first late seizures when administered within one day post injury; however, it does not impact late seizures when administered outside that time frame.
     
  • Surgical resection can reduce seizures if the focus of the seizures can be localized.