脑外伤癫痫.pptVIP

Seizure Risk and Management in TBI: Learning from Experimental and Case Studies Jeffrey Englander, MD Santa Clara Valley Medical Center San Jose, CA 95128 408 885-2000/ fax 408 885-2024 Posttraumatic Seizure (PTS) Risk and Management in TBI: Objectives Guidelines for PTS prophylaxis: AANS, AAPMR Predict PTS risk based on clinical presentation Analyze treatment strategies for individuals with late PTS from case study Posttraumatic Seizure (PTS) definition Temporary brain dysfunction with excessive, hypersynchronous discharge of cortical neurons Immediate: first 24 hours post injury Early PTS: first 7 days Late PTS: after one week Epilepsy Recurrent unprovoked seizures TBI accounts for 5-20% symptomatic epilepsy in general population Early PTS - 3-15% adults, 10-15% children; 17-33% develop late PTS, adults children Late PTS - 86% recurrent seizures in 2 yrs (Haltiner et al, 1997) Consumer Feedback early 1990’s: Anticonvulsants (AED) No Standard of care: AEDs continued indefinitely MDs reluctant to discontinue medications, especially prescribed by another MD Memory problems and compliance Drug side effects: ataxia, rashes, periodontal care, hair growth or loss, slowed thinking Cost of medications, laboratory tests AANS(1995, 2000) and AAPMR(1998) Practice Parameters Recognize effects of AEDs on recovery, compliance Lack of efficacy in prevention of late PTS Option: Phenytoin, carbamazepine may prevent early PTS in high risk TBI; early PTS treatment does not prevent late PTS or improve outcome Standard: Prophylactic anticonvulsants not recommended for prevention of late PTS Traditional Risk Factors for late PTS Penetrating shrapnel injuries, military: 53% over 15 years (Salazar, 1985) Coma 3 weeks: 25% (Guidice, 1987) Early PTS-late PTS: 17-33%, age related in some studies Intracranial hematoma: Epidural, 22%; subdural or intracerebral, 45% (Jennett, 1975) Multi-center study rationale What is natural history late PTS with new guidelines? CT scan findi