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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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.	钱忠心, 孙伟, 刘卫东, 等. 颅骨修补前后脑血流变化的CT灌注评价. 临床神经外科杂志, 2012, 9(2): 107-109.
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12.	中国抗癫痫协会专家组. 颅脑疾病手术后抗癫痫药物应用的专家共识(试行). 中华神经外科杂志, 2012, 28(7): 751-754.
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14.	罗新名, 焦秋云, 刘正义, 等. 颅骨缺损状态下颅内压力的变化. 前卫医药杂志, 2001, 18(2): 103-104.
15.	张柏林, 张震宇, 李卫, 等. 颅骨缺损成形术后并发癫痫发作的临床分析. 中国当代医药, 2016, 23(36): 42-44.
16.	秦绍森, 国红, 苏闻. 中风后癫痫的临床研究. 中国神经免疫学和神经病学杂志, 1996, 12(1): 46-48.
17.	杨明华. 50例中风后继发癫痫的临床分析. 脑与神经疾病杂志, 2002, 10(1): 56-56.
18.	李玉方, 侯红军, 孟森. 脑血管病继发癫痫的临床分析. 中国实用神经疾病杂志, 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. 钱忠心, 孙伟, 刘卫东, 等. 颅骨修补前后脑血流变化的CT灌注评价. 临床神经外科杂志, 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. 中国抗癫痫协会专家组. 颅脑疾病手术后抗癫痫药物应用的专家共识(试行). 中华神经外科杂志, 2012, 28(7): 751-754.
13. 周可为, 朱林, 梁文龙. 外伤性颅骨缺损修补术后癫痫的诱发因素. 右江民族医学院学报, 2008, 30(5): 873-873.
14. 罗新名, 焦秋云, 刘正义, 等. 颅骨缺损状态下颅内压力的变化. 前卫医药杂志, 2001, 18(2): 103-104.
15. 张柏林, 张震宇, 李卫, 等. 颅骨缺损成形术后并发癫痫发作的临床分析. 中国当代医药, 2016, 23(36): 42-44.
16. 秦绍森, 国红, 苏闻. 中风后癫痫的临床研究. 中国神经免疫学和神经病学杂志, 1996, 12(1): 46-48.
17. 杨明华. 50例中风后继发癫痫的临床分析. 脑与神经疾病杂志, 2002, 10(1): 56-56.
18. 李玉方, 侯红军, 孟森. 脑血管病继发癫痫的临床分析. 中国实用神经疾病杂志, 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.

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Risk factors for secondary epilepsy after traumatic skull defect repair

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