Two-year longitudinal and prospective electroencephalographic follow-up in patients with TBI: can early EEG and CT findings predict post-traumatic epilepsy?

Introduction: Traumatic brain injury (TBI), caused by external force to the head, leads to anatomical or functional damage to cranial structures. It is a leading cause of morbidity and mortality in adults worldwide, with substantial economic burden. Post-traumatic epilepsy (PTE) is a significant complication of TBI, posing immense challenges to rehabilitation and exacerbating socioeconomic burdens. The incidence of PTE varies widely, underscoring the need for early detection and treatment.

Objective: Through prospective electroencephalography (EEG) evaluations over a two-year period, our study aims to identify electrographic patterns indicative of PTE development, offering crucial insights for timely intervention and improved patient outcomes.

Methods: Seventy-three adult participants with acute TBI, admitted to a reference hospital in Brazil between 2018 and 2020, were recruited based on eligibility criteria. EEG evaluations monitored seizure occurrence with follow-ups for up to 24 months post-TBI, though these were disrupted by the COVID-19 pandemic. Analyses included established EEG protocols, examining factors such as background activity and epileptiform paroxysms. Relative risk (RR), Multiple Correspondence Analysis (MCA), logistic regression, and Generalized Estimating Equations (GEE) were employed to predict variables associated with PTE development.

Results: Both PTE and NO-PTE (no post-traumatic epilepsy) patients showed improving background activity over 2 years. EEG recordings revealed that injuries in the temporal region, diffuse theta waves and abnormal bilateral sleep elements indicated a higher risk of PTE development. Additionally, multiple lesions were also associated with PTE.

Conclusion: This comprehensive approach provides valuable insights for clinical management and sheds light on the complex interplay of factors influencing TBI outcomes.