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Predicting Posttraumatic Epilepsy with MRI: Prospective Longitudinal Morphologic Study in Adults

Purpose: Evaluation of morphologic risk factors for posttraumatic epilepsy (PTE) by using brain magnetic resonance imaging (MRI) in serial assessments ≤2 years after traumatic brain injury (TBI). Methods: Brain MRI hyperintense (gliosis) or hypointense (hemosiderin) areas or both were assessed in th...

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Published in:Epilepsia (Copenhagen) 2005-09, Vol.46 (9), p.1472-1481
Main Authors: Messori, Anna, Polonara, Gabriele, Carle, Flavia, Gesuita, Rosaria, Salvolini, Ugo
Format: Article
Language:English
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Summary:Purpose: Evaluation of morphologic risk factors for posttraumatic epilepsy (PTE) by using brain magnetic resonance imaging (MRI) in serial assessments ≤2 years after traumatic brain injury (TBI). Methods: Brain MRI hyperintense (gliosis) or hypointense (hemosiderin) areas or both were assessed in the images of 135 adult TBI inpatients who completed a 2‐year clinical, EEG, and MRI study protocol. Overall clinical follow‐up for the development of PTE was 5–10 years (median, 102 months). Morphologic risk factors for PTE were evaluated by using Kaplan–Meier curves and Cox regression analysis. Results: In 20 patients, PTE developed. Kaplan–Meier curves showed that gliomesenchymal sequelae of focal brain lesions (subdural hematomas/contusions) that required surgical treatment (sSDH‐C) were a PTE risk factor (p < 0.001), as were sequelae of nonsurgical hemorrhagic contusions with gliosis wall incompletely surrounding hemosiderin dregs (IW) (p = 0.039) and mainly those with time‐related changes from incomplete to complete gliosis wall around hemosiderin (I/CW) (p = 0.005); those with early hemosiderin completely surrounded by gliosis (CW) were not (p = 0.821). Cox regression analysis showed that for patients with sequelae of sSDH‐C, the PTE risk was 4.38 (p = 0.023) times higher than for those who did not require surgical treatment or underwent surgery because of purely extradural hematoma; for those with IW and I/CW lesions, considered pooled, it was 6.61 times higher (p = 0.014) than for those with CW lesions. Conclusions: MRI follow‐up examination in the early chronic stage can differentiate among low‐, intermediate‐, and high‐risk sequelae of TBI. These findings yield new evidence for, but do not resolve, the debate on posttraumatic epileptogenesis.
ISSN:0013-9580
1528-1167
DOI:10.1111/j.1528-1167.2005.34004.x