| Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. | |
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MedLine Citation:
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PMID: 18090361 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE:: To determine whether nonconvulsive electrographic post-traumatic seizures result in increases in intracranial pressure and microdialysis lactate/pyruvate ratio. DESIGN:: Prospective monitoring with retrospective data analysis. SETTING:: Single center academic neurologic intensive care unit. PATIENTS:: Twenty moderate to severe traumatic brain injury patients (Glasgow Coma Score 3-13). MEASUREMENTS AND MAIN RESULTS:: Continuous electroencephalography and cerebral microdialysis were performed for 7 days after injury. Ten patients had seizures and were compared with a matched cohort of traumatic brain injury patients without seizures. The seizures were repetitive and constituted status epilepticus in seven of ten patients. Using a within-subject design, post-traumatic seizures resulted in episodic increases in intracranial pressure (22.4 +/- 7 vs. 12.8 +/- 4.3 mm Hg; p < .001) and an episodic increase in lactate/pyruvate ratio (49.4 +/- 16 vs. 23.8 +/- 7.6; p < .001) in the seizure group. Using a between-subjects comparison, the seizure group demonstrated a higher mean intracranial pressure (17.6 +/- 6.5 vs. 12.2 +/- 4.2 mm Hg; p < .001), a higher mean lactate/pyruvate ratio (38.6 +/- 18 vs. 27 +/- 9; p < .001) compared with nonseizure patients. The intracranial pressure and lactate/pyruvate ratio remained elevated beyond postinjury hr 100 in the seizure group but not the nonseizure group (p < .02). CONCLUSION:: Post-traumatic seizures result in episodic as well as long-lasting increases in intracranial pressure and microdialysis lactate/pyruvate ratio. These data suggest that post-traumatic seizures represent a therapeutic target for patients with traumatic brain injury. |
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Authors:
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Paul M Vespa; Chad Miller; David McArthur; Mathew Eliseo; Maria Etchepare; Daniel Hirt; Thomas C Glenn; Neil Martin; David Hovda |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2007-10-23 |
Journal Detail:
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Title: Critical care medicine Volume: - ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2007 Oct |
Date Detail:
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Created Date: 2007-12-19 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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From the departments of Neurosurgery (all) and Neurology (PMV, CM), University of California Los Angeles, Los Angeles, CA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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