2021/03/09 by Markus Karlander, Johan Ljungqvist, Johan Zelano · 58 citations
Medicine · #Cohort #Confidence interval #Epilepsy #Epilepsy research and treatment #Hazard ratio #Internal medicine #Medicine #Pediatrics #Proportional hazards model #Psychiatry #Traumatic Brain Injury Research #Traumatic Brain Injury and Neurovascular Disturbances #Traumatic brain injury
paper · pdf · doi:10.1136/jnnp-2020-325382
published in Journal of Neurology Neurosurgery & Psychiatry 92(6), 617-621 (BMJ)
openalex publication_date 2021/03/09 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/01
OBJECTIVE: Traumatic brain injury (TBI) is a leading cause of epilepsy. Our aim was to characterise the risk of epilepsy in adults after hospitalisation for TBI. METHODS: Register-based cohort study. All individuals aged 18-100 with a first hospitalisation for TBI in the comprehensive national patient register in Sweden between 2000 and 2010 (n=111 947) and three controls per exposed (n=325 881), matched on age and sex were included. Exposed individuals were categorised according to TBI severity. Kaplan-Meier curves were used to estimate the risk of epilepsy and Cox regression to estimate the hazard in univariate or multivariate regression. RESULTS: The 10-year risk of epilepsy was 12.9% (95% CI 11.7% to 14.1%) for focal cerebral injuries, 8.1% (95% CI 7.5% to 8.7%) for diffuse cerebral injuries, 7.3% (95% CI 6.9% to 7.7%) for extracerebral injuries, 2.8% (95% CI 2.4% to 3.2%) for skull fractures and 2.6% (95% CI 2.4% to 2.8%) for mild TBI. The risk of epilepsy after any TBI was 4.0% (95% CI 3.8% to 4.2%). The corresponding 10-year risk for controls was 0.9% (95% CI 0.9% to 0.9%). The HR increased with a more severe injury, from 3.0 (95% CI 2.8 to 3.2) for mild injury to 16.0 (95% CI 14.5 to 17.5) for focal cerebral injury. Multivariable analyses identified central nervous system (CNS) comorbidities as risk factors, but TBI remained significant also after adjustment for these. Other identified risk factors were male sex, age, mechanical ventilation and seizure during index hospitalisation. CONCLUSION: The risk of post-traumatic epilepsy is considerable, also with adjustments for CNS comorbidities.