Predictors of New-Onset Seizures in Head Trauma
Background. It is not known whether alcohol-related head trauma predicts the new-onset seizures, particularly alcohol-related seizures.
Objective. We investigated risk factors for new-onset seizures in a cohort of 739 head trauma subjects.
Methods. All subjects with head trauma attending Oulu University Hospital during 1999, including children and very old people but excluding persons with previous seizures and/or neurological diseases, were enrolled and followed up until the end of 2009. The Finnish National Hospital Discharge Register was used to identify all visits due to seizures during the 10-year follow-up. Dates of death were obtained from the official Cause-of-Death Statistics. Cox proportional hazard regression models and Kaplan-Meier survival curves were used to identify predictors of new-onset seizures.
Results. New-onset seizures were observed in 42 out of the 739 subjects (5.7%). An alcohol-related index injury (adjusted HR 2.50, 95% CI 1.30 to 4.82, p=0.006), moderate-to-severe traumatic brain injury (TBI) as the index trauma (3.13, 1.46 to 6.71, p=0.003) and preceding psychiatric disease (3.23, 1.23 to 9.21, p=0.028) were significant predictors of new-onset seizures during the follow-up after adjustment for age and sex. An alcohol-related index injury was the only independent predictor of the occurrence of an alcohol-related new-onset seizure (adjusted HR 12.13, 95% CI 2.70 to 54.50, p=0.001), and these seizures (n=19) developed more frequently among subjects without (n=14) than with (n=5) TBI.
Conclusions. We conclude that alcohol-related head trauma predicts new-onset seizures, particularly alcohol-related seizures. A brief intervention is needed in order to prevent the development of alcohol-related seizures.
Head traumas and acute symptomatic seizures are typical health problems caused by alcohol. Traumatic brain injury (TBI) and substance-use disorders frequently co-occur, but the relationship between heavy drinking, the severity of a head trauma and seizures is complex. The risk of seizures increases after TBI, but this depends on both the severity and type of injury. Both moderate-to-severe and penetrating TBI can frequently be followed by seizures, and one study has found brain contusion with subdural haematoma, skull fracture, loss of consciousness (LOC) or amnesia for more than 1 day and an age of 65 years or older to be significant risk factors for seizures following TBI, while another has reported that alcohol abuse may predispose individuals to the occurrence of seizures after cerebral contusion.
Since the risks of subjects with head traumas of differing severity, that is, with or without TBI, developing new-onset seizures, the risk factors involved and the relation of these to alcohol consumption are unknown, we conducted a prospective cohort study among unselected head trauma subjects to demonstrate whether new-onset seizures are associated with alcohol consumption. We hypothesised that an alcohol-related index trauma may be a predictor of new-onset seizures irrespective of trauma severity, as minor head traumas are frequent among those with heavy binge drinking, which in turn may provoke seizures.
Abstract and Introduction
Abstract
Background. It is not known whether alcohol-related head trauma predicts the new-onset seizures, particularly alcohol-related seizures.
Objective. We investigated risk factors for new-onset seizures in a cohort of 739 head trauma subjects.
Methods. All subjects with head trauma attending Oulu University Hospital during 1999, including children and very old people but excluding persons with previous seizures and/or neurological diseases, were enrolled and followed up until the end of 2009. The Finnish National Hospital Discharge Register was used to identify all visits due to seizures during the 10-year follow-up. Dates of death were obtained from the official Cause-of-Death Statistics. Cox proportional hazard regression models and Kaplan-Meier survival curves were used to identify predictors of new-onset seizures.
Results. New-onset seizures were observed in 42 out of the 739 subjects (5.7%). An alcohol-related index injury (adjusted HR 2.50, 95% CI 1.30 to 4.82, p=0.006), moderate-to-severe traumatic brain injury (TBI) as the index trauma (3.13, 1.46 to 6.71, p=0.003) and preceding psychiatric disease (3.23, 1.23 to 9.21, p=0.028) were significant predictors of new-onset seizures during the follow-up after adjustment for age and sex. An alcohol-related index injury was the only independent predictor of the occurrence of an alcohol-related new-onset seizure (adjusted HR 12.13, 95% CI 2.70 to 54.50, p=0.001), and these seizures (n=19) developed more frequently among subjects without (n=14) than with (n=5) TBI.
Conclusions. We conclude that alcohol-related head trauma predicts new-onset seizures, particularly alcohol-related seizures. A brief intervention is needed in order to prevent the development of alcohol-related seizures.
Introduction
Head traumas and acute symptomatic seizures are typical health problems caused by alcohol. Traumatic brain injury (TBI) and substance-use disorders frequently co-occur, but the relationship between heavy drinking, the severity of a head trauma and seizures is complex. The risk of seizures increases after TBI, but this depends on both the severity and type of injury. Both moderate-to-severe and penetrating TBI can frequently be followed by seizures, and one study has found brain contusion with subdural haematoma, skull fracture, loss of consciousness (LOC) or amnesia for more than 1 day and an age of 65 years or older to be significant risk factors for seizures following TBI, while another has reported that alcohol abuse may predispose individuals to the occurrence of seizures after cerebral contusion.
Since the risks of subjects with head traumas of differing severity, that is, with or without TBI, developing new-onset seizures, the risk factors involved and the relation of these to alcohol consumption are unknown, we conducted a prospective cohort study among unselected head trauma subjects to demonstrate whether new-onset seizures are associated with alcohol consumption. We hypothesised that an alcohol-related index trauma may be a predictor of new-onset seizures irrespective of trauma severity, as minor head traumas are frequent among those with heavy binge drinking, which in turn may provoke seizures.
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