Risk factors for secondary epilepsy after traumatic skull defect repair_Journal of Epilepsy

Authors：

CHEN Jie ¹ ,  LEI Ding ²

1. Department of Neurosurgery, Sichuan Petroleum Hospital, Chengdu 610212, China;
2. Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu 610041, China;

Corresponding?author：

LEI Ding, Email: leidickc18@tom.com

Keywords：

Traumatic skull dafect repair; Epilepsy; Secondary; Related risk factors

DOI：

10.7507/2096-0247.20190058

Video：

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Objective To explore the related risk factors of epilepsy after traumatic skull defect repair.Methods The clinical data of 72 cases patients underwent cranial three-dimensional titanium mesh repair in Neurosurgery Department of Sichuan Baoshihua Hospital from February 2010 to December 2017 were collected and followed up for 6 months, retrospectively analysed the causes and operation problems of secondary epilepsy after repair.Results 21 casese (29.2%) among the 72 cases patients underwent cranioplasty were found with secondary epilepsy. Univariate analysis showed that the rate of secondary epilepsy in patients with softening lesion of gray matter, no formal antiepileptic treatment after the first operation, suspension of dural during operation and repair time of the trauma >6 months was significantly higher than that in patients without secondary epilepsy (P<0.05). Multivariate Logistic regression was used to correct the results, showing that softening lesion in the gray matter [OR=8.425, 95% CI (2.541, 27.934), P<0.001)], no formal antiepileptic treatment after the first operation [OR=0.160, 95% CI (0.050, 0.518), P=0.002], intra-operative suspended dural [OR=13.306; 95% CI (3.769, 46.976), P<0.001] and repair time of trauma >6 months [OR=6.205, 95% CI (1.705, 22.583], P=0.006] were independent risk factors of secondary epilepsy.Conclusion After decompression of bone flap, regular antiepileptic therapy, shortening repair time, and proper peroperative management can reduce the incidence of postoperative epilepsy.

Citation： CHEN Jie, LEI Ding. Risk factors for secondary epilepsy after traumatic skull defect repair. Journal of Epilepsy, 2019, 5(5): 363-366. doi: 10.7507/2096-0247.20190058 Copy

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2.	Dixon KJ. Pathophysiology of traumatic Bbrain injury. Physical Medicine & Rehabilitation Clinics of North America, 2017, 28(2): 215-225.
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5.	Irimia A, Horn JDV. Epileptogenic focus localization in treatment-resistant post-traumatic epilepsy. Journal of Clinical Neuroscience, 2015, 22(4): 627-631.
6.	Gu B, Huang YZ, He XP, et al. A peptide uncoupling BDNF receptor TrkB from phospholipase Cγ1 prevents epilepsy induced by status epilepticus. Neuron, 2015, 88(3): 484-491.
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8.	Sarov M, Guichard JP, Chibarro S, et al. Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction. Stroke, 2010, 41(41): 560-562.
9.	Romero FR, Zanini MA, Ducati LG, et al. Sinking skin flap syndrome with delayed dysautonomic syndrome—an atypical presentation. International Journal of Surgery Case Reports, 2013, 4(11): 1007-1009.
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14.	羅新名, 焦秋云, 劉正義, 等. 顱骨缺損狀態下顱內壓力的變化. 前衛醫藥雜志, 2001, 18(2): 103-104.
15.	張柏林, 張震宇, 李衛, 等. 顱骨缺損成形術后并發癲癇發作的臨床分析. 中國當代醫藥, 2016, 23(36): 42-44.
16.	秦紹森, 國紅, 蘇聞. 中風后癲癇的臨床研究. 中國神經免疫學和神經病學雜志, 1996, 12(1): 46-48.
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18.	李玉方, 侯紅軍, 孟森. 腦血管病繼發癲癇的臨床分析. 中國實用神經疾病雜志, 2007, 10(4): 95-96.
19.	Santis AD, Sganzerla E, Spagnoli D, et al. Risk factors for late posttraumatic epilepsy. Neurotraumatology: . Progress and Perspectives, 1992: 64-67.

1. Fisher RS. An overview of the 2017 ILAE operational classification of seizure types. Epilepsy Behav, 2017, 70(Pt A): 271-273.
2. Dixon KJ. Pathophysiology of traumatic Bbrain injury. Physical Medicine & Rehabilitation Clinics of North America, 2017, 28(2): 215-225.
3. Aguiar CCT, Almeida AB, Araújo PVP, et al. Oxidative stress and epilepsy: literature review. Oxidative Medicine and Cellular Longevity, 2012, 5: 1-12.
4. Algattas H, Huang JH. Traumatic brain injury pathophysiology and treatments: early, intermediate, and late phases post-injury. International Journal of Molecular Sciences, 2014, 15(1): 309.
5. Irimia A, Horn JDV. Epileptogenic focus localization in treatment-resistant post-traumatic epilepsy. Journal of Clinical Neuroscience, 2015, 22(4): 627-631.
6. Gu B, Huang YZ, He XP, et al. A peptide uncoupling BDNF receptor TrkB from phospholipase Cγ1 prevents epilepsy induced by status epilepticus. Neuron, 2015, 88(3): 484-491.
7. Lee L, Ker J, Quah BL, et al. A retrospective analysis and review of an institution's experience with the complications of cranioplasty. British Journal of Neurosurgery, 2013, 27(5): 629-635.
8. Sarov M, Guichard JP, Chibarro S, et al. Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction. Stroke, 2010, 41(41): 560-562.
9. Romero FR, Zanini MA, Ducati LG, et al. Sinking skin flap syndrome with delayed dysautonomic syndrome—an atypical presentation. International Journal of Surgery Case Reports, 2013, 4(11): 1007-1009.
10. 錢忠心, 孫偉, 劉衛東, 等. 顱骨修補前后腦血流變化的CT灌注評價. 臨床神經外科雜志, 2012, 9(2): 107-109.
11. Coelho F, Oliveira AM, Paiva WS, et al. Comprehensive cognitive and cerebral hemodynamic evaluation after cranioplasty. Neuropsychiatric Disease & Treatment, 2014, 10: 695-701.
12. 中國抗癲癇協會專家組. 顱腦疾病手術后抗癲癇藥物應用的專家共識(試行). 中華神經外科雜志, 2012, 28(7): 751-754.
13. 周可為, 朱林, 梁文龍. 外傷性顱骨缺損修補術后癲癇的誘發因素. 右江民族醫學院學報, 2008, 30(5): 873-873.
14. 羅新名, 焦秋云, 劉正義, 等. 顱骨缺損狀態下顱內壓力的變化. 前衛醫藥雜志, 2001, 18(2): 103-104.
15. 張柏林, 張震宇, 李衛, 等. 顱骨缺損成形術后并發癲癇發作的臨床分析. 中國當代醫藥, 2016, 23(36): 42-44.
16. 秦紹森, 國紅, 蘇聞. 中風后癲癇的臨床研究. 中國神經免疫學和神經病學雜志, 1996, 12(1): 46-48.
17. 楊明華. 50例中風后繼發癲癇的臨床分析. 腦與神經疾病雜志, 2002, 10(1): 56-56.
18. 李玉方, 侯紅軍, 孟森. 腦血管病繼發癲癇的臨床分析. 中國實用神經疾病雜志, 2007, 10(4): 95-96.
19. Santis AD, Sganzerla E, Spagnoli D, et al. Risk factors for late posttraumatic epilepsy. Neurotraumatology: . Progress and Perspectives, 1992: 64-67.

Journal of Epilepsy

Risk factors for secondary epilepsy after traumatic skull defect repair

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