Risk of Post-Traumatic Seizures in Temporal Lobe Intracranial Bleeding

Risk Factors and Incidence

Early post-traumatic seizures (within 7 days of injury) occur in approximately 2.2% of all traumatic brain injury cases, but the incidence is much higher in severe TBI cases 1
Late seizures (after 7 days) occur in about 2.1% of all TBI cases, but the incidence rises to 11.9% in the first year for severe TBI patients 1
Initial loss of consciousness or amnesia for more than 24 hours is a specific risk factor for post-traumatic seizures 1
Age over 65 years is a specific risk factor for post-traumatic seizures 1

Head CT is the preferred initial imaging modality for post-traumatic seizures to identify acute intracranial hemorrhage or mass effect that may require urgent intervention 2
CT can identify 100% of acutely treatable lesions in patients with post-traumatic seizures, with approximately 7% requiring urgent surgical intervention 2
MRI is more sensitive than CT for detecting microhemorrhages and diffuse axonal injury but is less practical in the acute setting 2
Continuous EEG monitoring should be considered in patients with depressed mental status disproportionate to their brain injury to detect subtle seizure activity 2

Antiepileptic prophylaxis is not routinely recommended for primary prevention of post-traumatic seizures 1
If antiepileptic medication is used, levetiracetam is preferred over phenytoin due to better tolerability and lack of significant drug interactions 3

The presence of early seizures does not necessarily predict late seizures in all multivariate analyses 1
Craniectomy has been identified as a possible risk factor for early post-traumatic seizures 1

The risk assessment should include evaluation for all risk factors, not just the temporal lobe location 1

Neurologic deficit is associated with an increased risk of post-traumatic seizures, with an odds ratio of 2-19 across studies, according to the American College of Emergency Physicians 4
Signs of basilar skull fracture increase the risk of post-traumatic seizures, with an odds ratio of 10-14 across studies, as reported by the American College of Emergency Physicians 4
Severe headache is a risk factor for post-traumatic seizures, with an odds ratio of 3, as noted by the American College of Emergency Physicians 4
Vomiting is associated with an increased risk of post-traumatic seizures, with an odds ratio of 3-5, according to the American College of Emergency Physicians 4
Post-traumatic amnesia increases the risk of post-traumatic seizures, with an odds ratio of 1.7-8, as reported by the American College of Emergency Physicians 4
Loss of consciousness is a risk factor for post-traumatic seizures, with an odds ratio of 2-7, as noted by the American College of Emergency Physicians 4
Posttraumatic seizure is associated with an increased risk of subsequent seizures, with an odds ratio of 3, according to the American College of Emergency Physicians 4