Associations between post-traumatic seizures, antiseizure medication, and duration of post-traumatic amnesia: a retrospective cohort analysis.

Abstract

To evaluate the relationship between posttraumatic seizure (PTS) and anti-seizure medications (ASMs) use with post-traumatic amnesia (PTA) duration. Retrospective study. Guttmann Institute, Neurorehabilitation Hospital (Badalona, Barcelona, Spain). Patients with PTA following traumatic brain injury (TBI) admitted for rehabilitation between February 2002 and May 2024. none. Age, gender, Glasgow Coma Scale (GCS) score, Galveston Orientation and Amnesia Test (GOAT) scores at admission and discharge, presence of PTS and ASM use, and PTA duration (days from TBI to PTA emergence). Group comparisons were conducted between patients with or without PTS and ASM use to identify differences in clinically relevant variables related with PTA duration. Cox proportional-hazards models were conducted to estimate PTA duration. A total of 352 patients (80.4% male; median age: 39.54 years) were distributed into four groups: Treatment-PTS (N=64, ASM for PTS), Prophylactic-ASM (N=46, ASM to prevent PTS), Behavior/Pain-ASM (N=160, ASM for behavioral impairment or neuropathic pain but no PTS), and noASM (N=82). Median PTA duration was shortest in noASM (59.1 days [IQR: 48.6-89.7]) compared to Treatment-PTS (74.7 [IQR: 55.5-111.5]), Prophylactic-ASM (84.5 [IQR: 59.0-102.2]) and Behavior/Pain-ASM (78.1 [56.6-102.5]) (p=0.02). Older age (HR: 0.98; 95% CI: 0.98 - 0.99), lower admission GOAT scores (HR: 1.02; 95% CI: 1.02 - 1.03), and being on Treatment for PTS as compared to noASM (HR:0.58; 95 % CI: 0.38-0.88) or Behavior/Pain-ASM (HR: 0.61; 95 % CI 0.42-0.89) had significant negative association with the PTA duration. ASM use, older age and lower GOAT score are associated with longer PTA duration. The high use rates of ASMs in TBI patients extending beyond those with PTS underscores the importance of careful evaluation of ASM use to optimize outcomes in TBI patients with PTA.