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Table 10.8 Studies Examining Surgical Treatment of Post-Traumatic Seizures

Author Year

Country

Research Design

PEDro

Sample Size

Methods Outcome

Won et al. (2017)

Germany

Cohort

N=139

 

Population: (subdural hematoma): Mean Age=72.7yr; Gender: Males=94, Females=45; GCS: ≤8=73, >8=66.

Intervention: Patients either received a craniotomy or a craniectomy.

Outcome Measure: Risk factors for seizure incidence, seizure frequency, functional outcome at 3 mo.

1.        A GCS score of ≤8 was seen as a significant predictor of post-traumatic seizures (p=0.03). Additionally, having a GCS score of ≤8 24hr post-op was also seen to significantly predict post-traumatic seizures (p=0.008).

2.        There was no significant difference in terms of seizure frequency between those who received a craniotomy compared to a craniectomy (p=0.06).

3.        There was no significant difference in functional outcomes between groups.

Zheng et al. (2013)

USA

Case Series

N=97

Population: Tumor; Mean Age=51.4yr; Gender: Male=38, Female=59.

Treatment: Patients with supratentorial meningioma were retrospectively analyzed after surgical resection for postoperative seizures. Seizures were divided into postoperative early (<1wk) and late (>1wk) occurrence.

Outcome Measure: Seizure rates.

1.        Sixty-two (63.9%) of the 97 patients were seizure free for the entire postoperative follow-up. 2.        Thirteen (13.4%) of the 97 patients experienced frequent seizures. 3.        Fourteen (14.4%) of the 97 patients experienced early postoperative seizures. 4.        Thirty-three (34.0%) of the 97 patients experienced late postoperative seizures include 12 of the 14 patients who experienced early seizures.

Hakimian et al. (2012)

USA

Case Series

N=21

Population: TBI; Mean Age=34.7yr; Gender: Male=12, Female=9; Time Post Injury=12.9yr. Treatment: Retrospective review of patients who had an extratemporal resection (with or without temporal lobectomy) for medically intractable epilepsy.

Outcome Measure: Occurrence of seizures (mean follow-up was 7yr).

1.        Most patients had both frequent complex partial and generalized tonic-clonic seizures and were unsuccessfully treated with an average of 4.15 antiepileptic drugs.

2.        Six patients were seizure-free, six patients had rare seizures (≤2/yr), five had a reduction in frequency, and 4 had no benefit from the surgery.

3.        Two patients had significant complications (subdural hematomas).

Marks et al.

(1995)

USA

Case Series

N=25

Population: Head Trauma; Gender: Male=17, Female=8.

Treatment: Participants underwent surgical resection when seizures could be localized.

Outcome Measure: Occurrence of seizures.

 

1.        Prior to surgery seizures were localized to the mesial temporal region (Group 1, n=17) and extrahippocampal neocortical area (Group 2, n=8).

2.        Nine patients had their seizures successfully localized and underwent a surgical procedure. Afterwards, all were seizure free.

3.        16 patients did not have their seizures adequately localized.