Causes |
- Head Trauma: Traumatic brain injury (TBI) is the primary cause, with the risk being higher in more severe injuries such as:
- Penetrating head injuries
- Severe concussions
- Contusions and intracranial haemorrhages
- Skull fractures
- Secondary Factors:
- Post-injury infections (e.g., meningitis)
- Brain swelling (cerebral edema)
- Secondary brain hypoxia or ischaemia
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Clinical Features |
- Seizure Onset: Seizures can occur immediately after injury (within 24 hours), within a week (early post-traumatic seizures), or after more than a week (late post-traumatic seizures, which are more likely to lead to PTE).
- Seizure Types:
- Focal seizures (with or without impaired awareness)
- Generalized tonic-clonic seizures
- Associated Symptoms: May include headaches, confusion, memory problems, mood disturbances, and neurological deficits depending on the location of the injury.
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Investigations |
- Neuroimaging:
- CT Scan: Initially used to assess for acute injuries such as fractures, haemorrhages, and contusions.
- MRI: Preferred for detecting chronic structural changes, gliosis, scarring, and subtle injuries not visible on CT.
- Electroencephalogram (EEG): Used to identify epileptiform activity and to localize seizure foci. Useful for both diagnosis and monitoring.
- Neuropsychological Testing: May be used to assess cognitive function, especially if there are concerns about memory or other cognitive deficits post-injury.
- Laboratory Tests: Blood tests to rule out metabolic causes of seizures and monitor for potential side effects of antiepileptic drugs (AEDs).
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Management |
- Acute Seizure Management:
- Stabilize the patient’s airway, breathing, and circulation (ABCs).
- Administer benzodiazepines (e.g., lorazepam) to control acute seizures.
- Long-Term Management:
- Antiepileptic Drugs (AEDs):
- First-line treatment to prevent recurrent seizures. Options include levetiracetam, lamotrigine, and phenytoin, among others.
- Choice of AED may depend on the type of seizures, side effect profile, and patient comorbidities.
- Monitoring and Follow-Up: Regular follow-up to monitor seizure control, medication side effects, and adjust treatment as necessary.
- Surgical Intervention:
- Considered for patients with drug-resistant epilepsy, particularly when seizures are localized to a specific area of the brain.
- Options include resection of the epileptic focus or vagus nerve stimulation (VNS).
- Rehabilitation:
- Physical therapy, occupational therapy, and cognitive rehabilitation to address deficits caused by the initial injury and seizures.
- Patient Education:
- Educate the patient and family about seizure precautions, medication adherence, and lifestyle modifications to reduce seizure triggers.
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