RT Journal Article
SR Electronic
T1 Self-Reported Severity and Causes of Traumatic Brain Injury in Patients With Epileptic or Functional Seizures
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP 10.1212/CPJ.0000000000200098
DO 10.1212/CPJ.0000000000200098
A1 L. Brian Hickman
A1 Akash B. Patel
A1 Ishita Dubey
A1 Amir H. Karimi
A1 Xingruo Zhang
A1 Emily A. Janio
A1 Corinne H. Allas
A1 Siddhanka S. Sreenivasan
A1 Janar Bauirjan
A1 Shannon D'Ambrosio
A1 Mona Al Banna
A1 Andrew Y. Cho
A1 Jerome Engel, Jr
A1 John M. Stern
A1 Wesley T. Kerr
YR 2022
UL http://cp.neurology.org/content/early/2022/10/27/CPJ.0000000000200098.abstract
AB Background: While moderate and severe traumatic brain injury (TBI) can cause post-traumatic epilepsy, many patients with functional seizures (FS) also report a history of mild TBI. To determine if features of TBI history differs between patients with epileptic seizures (ES) and FS, we compared patient reports of TBI severity, symptoms, and causes of injury.Methods: We recruited patients undergoing video-EEG evaluation for diagnosis of ES, FS, mixed ES and FS, or physiologic seizure-like events at an academic, tertiary referral center. Patients and their caregivers were interviewed prior to final video-EEG diagnosis regarding their TBI histories, including concussive symptoms and causes of injury.Results: Of 506 patients, a greater percentage of patients with FS reported a history of TBI than patients with ES (70% vs 59%, aOR=1.75 [95% confidence interval: 1.00-3.05], p=0.047). TBI with loss of consciousness (LOC) lasting less than 30 minutes was more frequently reported among patients with functional seizures than with ES (27% vs 13%, aOR=2.38 [1.26-4.47], p<0.01). The proportion of patients reporting other neurological symptoms immediately after TBI was not significantly different between FS and ES (40% vs 29%, p=0.08). Causes of TBI were found to differ, with TBIs caused by falls from a height (17% vs 10%, aOR=2.24 [1.06-4.70], p=0.03) or motor vehicle collisions (27% vs 11%, aOR=2.96 [1.54-5.67], p<0.01) reported more frequently in FS than ES.Discussion: Our findings further the association of mild TBI with FS and prompt reconsideration of typical assumptions regarding the significance of reported TBI history in patients with previously undifferentiated seizures. While common in both groups, TBI with LOC less than 30 minutes and causes of injury that are commonly thought to be more severe were reported more frequently in FS than ES. This suggests that patient or caregiver reporting of these features does not imply post-traumatic epilepsy is a more probable diagnosis than FS. While history of TBI with LOC and presumed high-risk causes of injury intuitively raises suspicion for post-traumatic epilepsy, clinicians should be cautioned that these historical factors also were a frequent finding in patients with FS.