Does glucocorticoid administration prevent late seizures after head injury?
OBJECTIVE
Preventing posttraumatic epilepsy has been a difficult challenge. In this study we evaluated the association between glucocorticoid administration after traumatic brain injury (TBI) and posttraumatic seizures.


METHODS
We examined a seizure-prevention trial database of 404 patients with severe TBI for exposure to glucocorticoids in the early (<1 week) posttraumatic period. After controlling for seizure risk, we compared the odds of developing first and second late posttraumatic seizures between those that received glucocorticoids and those that did not.


RESULTS
Patients dosed with glucocorticoids within 1 day of their TBI were more likely to develop first late seizures than were those without [p = 0.04; hazard ratio = 1.74; 95% confidence interval (CI), 1.01-2.98]; whereas those receiving glucocorticoids > or =2 days after their injury had no similar association (p = 0.66; hazard ratio = 0.77; 95% CI, 0.23-2.56; p = 0.10 among the three groups). Receiving glucocorticoids within 1 day, or > or =2 days after TBI was not associated with second late seizure development.


CONCLUSIONS
Glucocorticoid treatment after TBI is not associated with decreased late posttraumatic seizures, and early treatment is associated with increased seizure activity.
Watson
Nathaniel F
NF
Neurology and Sleep Disorders Center, University of Washington, Seattle, Washington 98104-2499, USA. nwatson@u.washington.edu
Barber
Jason K
JK
Doherty
Michael J
MJ
Miller
John W
JW
Temkin
Nancy R
NR
D000328:Adult; D001929:Brain Edema / Q000517:prevention & control; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000150:complications*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004834:Epilepsy, Post-Traumatic / Q000517:prevention & control*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D005938:Glucocorticoids