Epileptic seizures after the combat traumatic brain injury. The role and place of antiepileptic therapy

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Abstract

BACKGROUND: Taking into account the increasing number of armed conflicts, the number of combat head traumatic injuries and their consequences, which are faced not only by military doctors, but also by civilian healthcare, is thereof increasing.

AIM: The purpose of this article is to focus the attention of practicing neurologists and neurosurgeons to the modern principles of diagnostic and treatment of post-traumatic epileptic seizures after high-energy combat traumatic brain injury of various severity.

MATERIALS AND METHODS: The article presents the discussion of the clinical application of a number of theoretical concepts, definitions and recommendations used in cases to epileptic seizures after trauma and post-traumatic epilepsy. A prospective analysis of 224 patients with severe combat traumatic brain injury is presented. To evaluate different approaches to preventive therapy of epileptic seizures, the entire cohort of patients was divided into two groups: the first group (n = 122, 54.5% of patients) — without prophylactic use of antiepileptic drugs; the second group (n = 102, 45.5% of patients) — with prophylactic use of antiepileptic drugs. All patients underwent EEG, CT of the brain, and MRI of the brain in the absence of metal fragments in the body. The follow-up period was 12–18 months. Data from 79 patients with concussion in the structure of mine-blast injury were analyzed separately.

RESULTS: The analysis of the incidence of early and late acute post-traumatic seizures is carried out, various approaches to their treatment are discussed, depending on the clinical and diagnostic findings. The historical aspect of comparing the incidence of post-traumatic epilepsy in major wars of the twentieth century and current armed conflicts is touched upon, taking into account the contemporary approaches — the availability of specialized medical care, the possibility of current methods of examination and therapy.

CONCLUSION: The results obtained in the work provide grounds for revising the strategy of prophylactic administration of antiepileptic drugs to patients with severe head injury in modern conditions of providing specialized care.

About the authors

Sergey N. Bazilevich

Military Medical Academy

Author for correspondence.
Email: basilevich@inbox.ru
ORCID iD: 0000-0002-4248-9321
SPIN-code: 9785-0471
Scopus Author ID: 6505963201
ResearcherId: J-1416-2016

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Saint Petersburg

Igor’ V. Litvinenko

Military Medical Academy

Email: vmeda-na@mil.ru
ORCID iD: 0000-0001-8988-3011
SPIN-code: 6112-2792
Scopus Author ID: 35734354000
ResearcherId: F-9120-2013

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Miroslav M. Odinak

Military Medical Academy

Email: odinak@rambler.ru
ORCID iD: 0000-0002-7314-7711
SPIN-code: 1155-9732
Scopus Author ID: 7003327776
ResearcherId: I-6024-2016

Corresponding Member of the Russian Academy of Sciences, MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Nikolay V. Tsygan

Military Medical Academy

Email: vmeda-na@mil.ru
ORCID iD: 0000-0002-5881-2242
SPIN-code: 1006-2845
Scopus Author ID: 37066611200
ResearcherId: H-9132-2016

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

References

  1. Guseva EI, Konovalova AN Skvortsova VI, ed. Neurology: National guidelines. Moscow: GEOTAR-Media; 2018. 1064 p. (In Russ.)
  2. Gusev E.I., Gekht A.B., Hauser W.A., et al. Epidemiology of epilepsy in the Russian Federation. In: Modern epileptology. Moscow; 2011. P. 77–85. (In Russ.) EDN: YYZRGP
  3. Frey LC. Epidemiology of posttraumatic epilepsy: a critical review. Epilepsia. 2003;44(s10):11–17. doi: 10.1046/j.1528-1157.44.s10.4.x
  4. Carney N, Totten AM, O’Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80(1):6–15. doi: 10.1227/NEU.0000000000001432
  5. Odinak MM, Kornilov NV, Gritsanov AI, et al. Neuropathology of contusion-commotion injuries of world and war times. Gritsanov AI, ed. Saint Petersburg: MORSAR AV; 2000. 432 p. (In Russ.)
  6. Litvinenko IV, Bazilevich SN, Odinak MM, et al. Military medical examination of military personnel with the consequences of closed traumatic brain injuries. Voen Med Zh. 2018.;339(5):15–22. (In Russ.) EDN: XYPNKH
  7. Litvinenko IV, Bazilevich SN, Odinak MM, et al. Epileptic seizures after concussion of the brain — an urgent and complex issue of military medical expertise. Voen Med Zh. 2021;342(1):27–37. (In Russ.) EDN: ZWRKSZ
  8. Odinak MM, Litvinenko IV, eds. Nervous diseases: a textbook for students of medical universities. Saint Petersburg: SpecLit; 2020. 575 p. (In Russ.)
  9. Clinical recommendations “Focal brain injury” Ministry of Health of the Russian Federation. 2022. 59 р. Available from: http://disuria.ru/_ld/12/1200_kr22S06MZ.pdf (In Russ.)
  10. Parfenov VE, Svistov DV, eds. Collection of lectures on topical issues of neurosurgery. Saint Petersburg: ELBI-SPb; 2008. 456 p. (In Russ.)
  11. Trishkin D.V., Kryukov E.V., Chuprina A.P., et al. Methodological recommendations for the treatment of combat surgical injury. Moscow: Ministry of Defense of the Russian Federation Main Military Medical Department; 2022. 373 p. (In Russ.)
  12. Beghi E, Carpio A, Forsgren L, et al. Recommendation for a definition of acute symptomatic seizure: Report from the ILAE Commission on Epidemiology. Epilepsia. 2010;51(4):671–675. doi: 10.1111/j.1528-1167.2009.02285.x
  13. Hesdorffer DC, Benn Emma KT, Cascino GD, Hauser WA. Is a first acute symptomatic seizures epilepsy? Mortality and risk for recurrent seizure. Epilepsia. 2009;50(5):1102–1108. doi: 10.1111/j.1528-1167.2008.01945.x
  14. Odinak MM, ed. Military neurology: textbook. Saint Petersburg: VMedA; 2004. 356 p. (In Russ.)
  15. Clinical recommendations “Epilepsy and epileptic status in adults and children”. Ministry of Health of the Russian Federation; 2022. 277 p. Available from: https://ruans.org/Text/Guidelines/epilepsy-2022.pdf (In Russ.)
  16. Тemkin NR, Dikmen SS, Wilensky AJ, et al. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med. 1990;323(8):497–502. doi: 10.1056/NEJM199008233230801
  17. Temkin NR, Dikmen SS, Anderson GD, et al. Valproate therapy for prevention of posttraumatic seizures: a randomized trial. J Neurosurg. 1999;91(4):593–600. doi: 10.3171/jns.1999.91.4.0593
  18. Inaba K, Menaker J, Branco BC, et al. A prospective multicenter comparison of levetiracetam versus phenytoin for early posttraumatic seizure prophylaxis. J Trauma Acute Care Surg. 2013;74(3): 766–771. doi: 10.1097/TA.0b013e3182826e84
  19. Tompson K., Pohlmann-Eden B., Campbell LA, Abel H. Pharmacological treatments for preventing epilepsy following traumatic head injury. Cochrane Database Syst Rev. 2015;2015(8): CD009900. doi: 10.1002/14651858.CD009900.pub2
  20. Bhullar I, Johnson D, Paul J, et al. More harm than good: antiseizure prophylaxis after traumatic brain injury does not decrease seizure rates but may inhibit functional recovery. J Trauma Acute Care Surg. 2014;76(1):54–60. doi: 10.1097/TA.0b013e3182aafd15
  21. Raymont V, Salazar A, Lpsky R, et al. Correlates of posttraumatic epilepsy 35 years following combat brain injury. Neurology. 2010;20(3):224–229. doi: 10.1212/WNL.0b013e3181e8e6d0
  22. Puras YuV, Talypov AE, Trifonov IS, Krylov VV Convulsive syndrome in the acute period of severe traumatic brain injury. Neurosurgery. 2011;(2):35–40. (In Russ.) EDN: NXTKHH
  23. Kardash AM, Listratenko AI, Kardash KA Combat trauma of the skull and brain during military operations in the megalopolis. International Scientific Research Journal. 2015;(10–4):58–60. (In Russ.) EDN: VHRTUZ doi: 10.18454/IRJ.2015.41.140
  24. Novelli A, Groppetti A, Rossoni G, et al. Nefopam is more potent than carbamazepine for neuroprotection against veratridine in vitro and has anticonvulsant properties against both electrical and chemical stimulation. Amino Acids. 2007;32(3):323–332. doi: 10.1007/s00726-006-0419-6
  25. Verleye M, Andre N, Heulard I, et al. Nefopam blocks voltage-sensitive sodium channels and modulates glutamatergic transmission in rodents. Brain Res. 2004;1013(2):249–255. doi: 10.1016/j.brainres.2004.04.035
  26. Fisher RS, Boas WV, Blume WT, et al. Epileptic seizures and epilepsy: Definition proposed by the International league against epilepsy (ILAE) and the International bureau for epilepsy (IBE). Epilepsia. 2005;46(4):470–472. doi: 10.1111/j.0013-9580.2005.66104.x
  27. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4): 475–482. doi: 10.1111/epi.12550
  28. Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline: management of an unprovoked first seizure in adults: report of the guideline development subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2015;84(16):1705–1713. doi: 10.1212/WNL.0000000000001487

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2. Fig. 1. Patient L. MRI of the brain — on coronal (а) and axial sections (б) (FLAIR mode) the area of contusion in the subcortical-cortical area of the left parietal lobe measuring up to 14 × 6 × 9 mm. Before the MRI, the patient had been treated for 6 days with a diagnosis of traumatic brain injury — brain commotion. According to CT of the head on the 3rd day after the injury, no structural disorders were detected

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3. Fig. 2. Patient L. EEG without signs of focal and paroxysmal activity at rest and during functional tests

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4. Fig. 3. Patient A. EEG in resting conditions shows regular, well-modulated, exalted, hypersynchronous, dominant alpha rhythm with a frequency of 10 oscillations per second, an amplitude of 140 mcV, symmetrical, distorted by bilaterally synchronous bursts of “sharp” waves with an amplitude of 210 mcV, duration of 1 s in the parietal-occipital leads. Zonal differences are impaired, the alpha rhythm periodically has a paroxysmal character

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5. Fig. 4. Patient V. EEG — at the junctions of the alpha rhythm spindles, a low-frequency beta rhythm with an amplitude of 13 mcV, complexes of “sharp-slow” wave with an amplitude of 101 mcV, a frequency of 3 oscillations/s, prevailing in the temporo-parietal-occipital region on the left more than on the right, periodically tending to synchronize

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6. Fig. 5. Patient S. CT — trepanation defect in the frontal-temporal-parietal region on the right, measuring 9.2 × 13.7 cm (defect area 153 cm2). A zone of cystic-atrophic changes in the right hemisphere is determined. The median structures are shifted to the left by up to 0.4 cm. The lateral ventricles are dilated and symmetrical. In the area of the body of the left lateral ventricle, there is a proximal edge of the ventricular shunt (history of mine-blast injury)

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7. Fig. 6. Patient G. No active complaints consistent with brain injury, conscious, no neurological symptoms. Upon examination, the entrance holes of a penetrating blind craniocerebral wound are visualized in the left temporal region (at the time of injury, consciousness was not lost). CT of the head — a hypodense wound channel with the presence of foreign bodies of bone density was detected in the left frontal region, the wound channel goes upwards into the right frontal region of the brain with the presence of a foreign body of metallic density

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8. Fig. 7. Patient D. Head CT — condition after resection-decompression trepanation of the parietal bone on the right; a massive area of cystic-atrophic changes is noted in the right occipital, both parietal lobes and the frontal lobe on the left with approximate dimensions of 105 × 20 mm; in the cortical sections of the left frontal lobe, a foreign body of metallic density with dimensions of 9 × 8 mm is noted

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9. Fig. 8. Patient D. EEG — slowing of the basic rhythm, without signs of focal and paroxysmal activity at rest and during functional tests

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10. Fig. 9. Patient F. Head CT — in the right hemisphere of the cerebellum, a hypodense wound channel was revealed with the presence of foreign bodies of bone density, single and grouped, with a total size of up to 4 × 6 mm; taking into account the ricochet wound, the wound channel goes upward through the cerebellum and the right cerebral peduncle with the presence of a foreign body of metallic density measuring 8 × 9 mm, located cranial to the enveloping cistern, to the right of the pineal gland

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11. Fig. 10. Patient F. EEG — within the normal range, without signs of epileptiform activity at rest and during functional tests

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