Abstracts

RATIONALE: Epilepsy is a common consequence of severe traumatic brain injury (TBI). Clinical trials involving anti-epileptic medications for the prevention of late post-traumatic seizures have been disappointing. Intravenous (IV) steroids are often administered following TBI to reduce cerebral edema. We investigated the effect of IV steroids administered in the immediate post-TBI period on the development of late post-traumatic seizures and epilepsy. At the end of this activity participants should be able to discuss the relationships between TBI, steroids, and seizures.
METHODS: We searched a database of 404 TBI patients for exposure to IV steroids within a week of their TBI. Exposure to any type or dose of steroid was considered significant, although most patients received at least 10 mg of Dexamethasone (Decadron). Steroid treatment was divided into occurring less than, or greater than, 24 hours following the TBI. A backward stepwise selection method was used to control for patient demographics and injury severity. Using this model we identified five variables that were associated with the development of late ([gt] 1 week following injury) post-traumatic seizures. These variables were non-reactive pupils, cortical contusions, intracranial hemorrhage, subdural hematoma, and seizures within one week of the TBI. Analysis was performed while controlling for these variables and any interactions via a multivariate Cox model.
RESULTS: Patients receiving steroids [lte] 24 hours after their TBI were 1.5 times more likely to develop a first late seizure than those that did not receive steroids ([italic]p[/italic]=0.14). This trend did not apply to second late seizure development ([italic]p[/italic]=0.48, Hazard Ratio 1.3). Patients receiving steroids [gt] 24 hours after their TBI were 1.2 times more likely to experience a first late seizure ([italic]p[/italic]=0.44), and 1.3 times more likely to experience a second late seizure ([italic]p[/italic]=0.49) than those that did not receive steroids.
CONCLUSIONS: Treatment with IV steroids in the immediate ([lte] 24 hours) post-TBI period may contribute to the development of a first late seizure. This is consistent with animal data showing hippocampal irregularities after glucocorticoid exposure. No trend was seen regarding the development of a second late seizure. Steroid exposure [gt] 24 hours after a TBI did not impact upon late seizure development.