Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis.
OBJECTIVE
To determine whether nonconvulsive electrographic post-traumatic seizures result in increases in intracranial pressure and microdialysis lactate/pyruvate ratio.


METHODS
Prospective monitoring with retrospective data analysis.


METHODS
Single center academic neurologic intensive care unit.


METHODS
Twenty moderate to severe traumatic brain injury patients (Glasgow Coma Score 3-13).


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 hour 100 in the seizure group but not the nonseizure group (p < .02).


CONCLUSIONS
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.
Vespa
Paul M
PM
Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA. pvespa@mednet.ucla.edu
Miller
Chad
C
McArthur
David
D
Eliseo
Mathew
M
Etchepare
Maria
M
Hirt
Daniel
D
Glenn
Thomas C
TC
Martin
Neil
N
Hovda
David
D
D016022:Case-Control Studies; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D004829:Epilepsy, Generalized / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D004834:Epilepsy, Post-Traumatic / Q000150:complications* / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000503:physiopathology; D019344:Lactic Acid / Q000378:metabolism*; D017551:Microdialysis; D008875:Middle Aged; D011446:Prospective Studies; D019289:Pyruvic Acid / Q000378:metabolism*; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000150:complications / Q000378:metabolism / Q000503:physiopathology
D019344:Lactic Acid; D019289:Pyruvic Acid