Epileptic seizures after the combat traumatic brain injury. The role and place of antiepileptic therapy

Abstract

BACKGROUND: Taking into account the increasing number of armed conflicts, the number of combat head traumatic injuries and their consequences, which are faced not only by military doctors, but also by civilian healthcare, is thereof increasing.

AIM: The purpose of this article is to focus the attention of practicing neurologists and neurosurgeons to the modern principles of diagnostic and treatment of post-traumatic epileptic seizures after high-energy combat traumatic brain injury of various severity.

MATERIALS AND METHODS: The article presents the discussion of the clinical application of a number of theoretical concepts, definitions and recommendations used in cases to epileptic seizures after trauma and post-traumatic epilepsy. A prospective analysis of 224 patients with severe combat traumatic brain injury is presented. To evaluate different approaches to preventive therapy of epileptic seizures, the entire cohort of patients was divided into two groups: the first group (n = 122, 54.5% of patients) — without prophylactic use of antiepileptic drugs; the second group (n = 102, 45.5% of patients) — with prophylactic use of antiepileptic drugs. All patients underwent EEG, CT of the brain, and MRI of the brain in the absence of metal fragments in the body. The follow-up period was 12–18 months. Data from 79 patients with concussion in the structure of mine-blast injury were analyzed separately.

RESULTS: The analysis of the incidence of early and late acute post-traumatic seizures is carried out, various approaches to their treatment are discussed, depending on the clinical and diagnostic findings. The historical aspect of comparing the incidence of post-traumatic epilepsy in major wars of the twentieth century and current armed conflicts is touched upon, taking into account the contemporary approaches — the availability of specialized medical care, the possibility of current methods of examination and therapy.

CONCLUSION: The results obtained in the work provide grounds for revising the strategy of prophylactic administration of antiepileptic drugs to patients with severe head injury in modern conditions of providing specialized care.

Keywords

acute symptomatic epileptic seizures / antiepileptic drug / combat brain injury / military trauma / penetrating head injuries / post-traumatic epilepsy / post-traumatic seizures / prophylaxis of epilepsy / prophylaxis of epileptic seizures / traumatic brain injury

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