DOI: https://doi.org/10.22141/2224-0713.6.100.2018.146452

Structure of convulsive syndrome in patients with acute traumatic brain injury

A.A. Shkiryak, O.M. Goncharuk, E.A. Askerov, A.A. Kaminskіy

Abstract


Background. The study of the structure of seizures, the time of their occurrence, the relationship with the type of traumatic brain injury help identify a group of patients who will need urgent surgical correction of their condition, the preventive use of antiepileptic drugs, as well as clarifying the impact of seizures on the outcome. The purpose is to study the structure of epileptic seizures in acute traumatic brain injury for optimization of diagnostic measures and therapy in these patients. Materials and methods. Clinical and instrumental examination was carried out and the results of the treatment of 779 patients with traumatic brain injury who had seizures were analyzed. The average age of patients was 35.5 ± 7.8 years. Most of the observations were criminal trauma — 320 cases (41.1 %), 272 injuries were the result of road accidents (34.9 %), 109 patients were traumatized when they fell from own height (13.9 %), in 78 patients, causes of trauma were unknown (10.0 %). Results. Epileptic seizures occur in 8.4 % of patients with acute traumatic brain injury. 81.4 % of persons had immediate epileptic seizures, 15.7 % — early epileptic seizures and 2.9 % — late epileptic seizures. Immediate and early seizures were more likely partial, in the structure of late epileptic seizures in acute traumatic brain injury, generalized seizures dominated. 422 patients (54.2 %) underwent urgent surgery. Surgery after neurological treatment was performed in 232 patients (29.8 %), conservative therapy was carried out in 125 patients (16.0 %). Conclusions. Neurological examination of patients with epileptic seizures in acute traumatic brain injury must be supplemented by computed tomography, regardless of the level of impaired consciousness in the patient. Emergency surgical intervention in such patients aimed at eliminating progressive dislocation is often the main method of treatment. Therapy by antiepileptic drugs should be performed after the appearance of a single seizure within a short period of time; in the presence of unprovoked epileptic seizures and their recurrence, the administration of antiepileptic drugs should be prolonged.


Keywords


epileptic seizures; acute traumatic brain injury

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