title: Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study.
abstract: Determine incidence of posttraumatic seizure (PTS) following traumatic brain injury (TBI) among individuals with moderate-to-severe TBI requiring rehabilitation and surviving at least 5 years.
  
  
  
  Using the prospective TBI Model Systems National Database, we calculated PTS incidence during acute hospitalization, and at years 1, 2, and 5 postinjury in a continuously followed cohort enrolled from 1989 to 2000 (n = 795). Incidence rates were stratified by risk factors, and adjusted relative risk (RR) was calculated. Late PTS associations with immediate (<24 h), early (24 h-7 day), or late seizures (>7 day) versus no seizure prior to discharge from acute hospitalization was also examined.
  
  
  
  PTS incidence during acute hospitalization was highest immediately (<24 h) post-TBI (8.9%). New onset PTS incidence was greatest between discharge from inpatient rehabilitation and year 1 (9.2%). Late PTS cumulative incidence from injury to year 1 was 11.9%, and reached 20.5% by year 5. Immediate/early PTS RR (2.04) was increased for those undergoing surgical evacuation procedures. Late PTS RR was significantly greater for individuals who self-identified as a race other than black/white (year 1 RR = 2.22), and for black individuals (year 5 RR = 3.02) versus white individuals. Late PTS was greater for individuals with subarachnoid hemorrhage (year 1 RR = 2.06) and individuals age 23-32 (year 5 RR = 2.43) and 33-44 (year 5 RR = 3.02). Late PTS RR years 1 and 5 was significantly higher for those undergoing surgical evacuation procedures (RR: 3.05 and 2.72, respectively).
  
  
  
  In this prospective, longitudinal, observational study, PTS incidence was similar to that in studies published previously. Individuals with immediate/late seizures during acute hospitalization have increased late PTS risk. Race, intracranial pathologies, and neurosurgical procedures also influenced PTS RR. Further studies are needed to examine the impact of seizure prophylaxis in high-risk subgroups and to delineate contributors to race/age associations on long-term seizure outcomes.
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.|Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Ritter
authors.affiliation: Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.|Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.|Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.|Center for Neuroscience at University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Wagner
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fabio
authors.affiliation: South Texas Veterans Health Care System Polytrauma Rehabilitation Center, San Antonio, Texas, U.S.A.|Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.affiliation: Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, U.S.A.
authors.forename: William C
authors.initials: WC
authors.lastname: Walker
authors.affiliation: Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
authors.forename: Jerzy P
authors.initials: JP
authors.lastname: Szaflarski
authors.affiliation: Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Zafonte
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Brown
authors.affiliation: Carolinas Rehabilitation, Charlotte, North Carolina, U.S.A.|Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
authors.forename: Flora M
authors.initials: FM
authors.lastname: Hammond
authors.affiliation: Rusk Rehabilitation, New York University School of Medicine, New York, New York, U.S.A.
authors.forename: Tamara
authors.initials: T
authors.lastname: Bushnik
authors.affiliation: Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Douglas
authors.initials: D
authors.lastname: Johnson-Greene
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Timothy
authors.initials: T
authors.lastname: Shea
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Krellman
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Rosenthal
authors.affiliation: Departments of Physical Medicine and Rehabilitation and Ophthalmology, The University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Dreer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000070642:Brain Injuries, Traumatic / Q000150:complications*; D015331:Cohort Studies; D004834:Epilepsy, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality / Q000534:rehabilitation; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D018709:Statistics, Nonparametric; D055815:Young Adult
keywords: Epidemiology; Epilepsy; Prophylaxis; Relative risk; TBI Model Systems