The Incidence and Prevalence of Epilepsy After a Traumatic Brain Injury: An International Systematic Review and Meta-Analysis
Abstract number :
2.394
Submission category :
16. Epidemiology
Year :
2019
Submission ID :
2421837
Source :
www.aesnet.org
Presentation date :
12/8/2019 4:04:48 PM
Published date :
Nov 25, 2019, 12:14 PM
Authors :
Nathalie Jette, Icahn School of Medicine at Mount Sinai; Sara Lukmanji, University of Calgary; Aysha Lukmanji, University of Caalgary; Tram Pham, University of British Columbia; Khara Sauro, University of Calgary; Ann Subota, University of Calgary; Callie
Rationale: Traumatic brain injury (TBI) is a public health concern due to its high incidence and associated neuropsychiatric sequelae, particularly post-traumatic epilepsy (PTE). We aimed to describe the epidemiology of epilepsy following a TBI and identify factors associated with the development of PTE. Methods: We searched EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews from inception until January 2018. Studies were included if they provided epidemiological data on PTE. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. Study-specific estimates were pooled, when feasible, using random effects meta-analyses. Sources of heterogeneity were explored using multiple meta-regression models. All analyses were conducted using STATA/SE 14.1. Results: We identified 3,752 unique abstracts, of which 73 were included in the systematic review and 70 in the meta-analysis. Pooled incidence proportion of epilepsy following TBI (n=81,324, 67 studies) is 11.0% (95% CI 8.0-13.0%). There is significant between-study heterogeneity (I2=99.04, p ≤ 0.001). Patients with combat zone injuries (n=6,545, 15 studies; 27.0%, 95% CI 19.0-35.0%) and early post-traumatic seizures (PTS) (n=504, 9 studies; 23.0%, 95% CI 13.0-35.0%) have significantly higher incidence proportions of PTE than the other subgroups analyzed. The incidence proportion of PTE is similar between males (n=5,296, 5 studies; 8.0%, 95% CI 5.0-11.0%) and females (n=1,578, 5 studies; 6.0%, 95% CI 3.0-10.0%) when combat injury studies are excluded. Incidence proportion is almost five times higher in severe TBI (n=4,609, 14 studies; 19.0%, 95% CI 10.0-29.0) compared to mild TBI (n= 9,291, 13 studies; 4.0%, 95% CI 1.0-7.0). No differences are seen between estimates of PTE in pediatric (n=9,266, 17 studies; 9.0%, 95% CI 6.0-11.0%) and adult (n=8,834, 5 studies; 6.0%, 95%CI 3.0-9.0%) subgroups. Conclusions: In this meta-analysis, over 1 in 10 patients with TBI will developed PTE. Combat injuries, severe TBI, and early PTS are associated with a higher incidence of PTE. These finding can inform future interventions targeting potential risk factors with the ultimate goal of PTE prevention and public health benefits. Funding: No funding
Epidemiology