Seizures and Cognitive Outcome After Traumatic Brain Injury: A Post Hoc Analysis

• Published in: Neurocritical care Vol. 36; no. 1; pp. 130 - 138
• Main Authors: Foreman, Brandon, Lee, Hyunjo, Mizrahi, Moshe A., Hartings, Jed A., Ngwenya, Laura B., Privitera, Michael, Tortella, Frank C., Zhang, Nanhua, Kramer, Joel H.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2022; Springer Nature B.V
• Subjects: Adult; Brain Injuries, Traumatic - complications; Cognition; Cognition & reasoning; Convulsions & seizures; Critical Care Medicine; Electroencephalography; Electroencephalography - methods; Humans; Informed consent; Intensive; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuropsychology; Neurosurgery; Original Work; Patients; Prospective Studies; Seizures - diagnosis; Trauma; Traumatic brain injury; Variables; Young Adult; United States > US; Cognition; Traumatic brain injury; Neurocritical care; Outcome; Continuous electroencephalography
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-021-01267-4

Introduction
Seizures and abnormal periodic or rhythmic patterns are observed on continuous electroencephalography monitoring (cEEG) in up to half of patients hospitalized with moderate to severe traumatic brain injury (TBI). We aimed to determine the impact of seizures and abnormal periodic or rhythmic patterns on cognitive outcome 3 months following moderate to severe TBI.
Methods
This was a post hoc analysis of the multicenter randomized controlled phase 2 INTREPID
2566
clinical trial conducted from 2010 to 2016 across 20 United States Level I trauma centers. Patients with nonpenetrating TBI and postresuscitation Glasgow Coma Scale scores 4–12 were included. Bedside cEEG was initiated per protocol on admission to intensive care, and the burden of ictal-interictal continuum (IIC) patterns, including seizures, was quantified. A summary global cognition score at 3 months following injury was used as the primary outcome.
Results
142 patients (age mean + / − standard deviation 32 + / − 13 years; 131 [92%] men) survived with a mean global cognition score of 81 + / − 15; nearly one third were considered to have poor functional outcome. 89 of 142 (63%) patients underwent cEEG, of whom 13 of 89 (15%) 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).
Conclusions
The burden of seizures and abnormal periodic or rhythmic patterns was independently associated with worse cognition at 3 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.