Incidence, Risk Factors, and Clinico-Radiological Correlations of Early Post-traumatic Seizures: A Prospective Analysis at a Tertiary Care Center in India

Background Post-traumatic epilepsy (PTE) is a major cause of acquired epilepsy. Early post-traumatic seizures (EPTS), occurring within the first seven days following traumatic brain injury (TBI), are known to worsen secondary brain damage and adversely affect patient outcomes. Despite the recognized burden, the incidence and risk factors of EPTS in the Indian population remain poorly characterized. Objective To determine the incidence of EPTS and identify the associated demographic, clinical, and radiological risk factors in patients presenting to a tertiary care neurosurgical institute. Methods This prospective observational study was conducted over two years (November 2019-October 2021) at the Department of Neurosurgery of a tertiary care teaching institute in India. A total of 1,035 consecutive patients with head injuries who presented to the emergency room were enrolled. Patients were started on levetiracetam 500 mg 12 hourly in adults and 20mg/kg 12 hourly in pediatric patients, in oral or intravenous (I.V.) route as per clinical assessment. The decision to start antiepileptics was clinical; not all patients received antiepileptics. However, a positive CT finding, prior history of seizures, or a Glasgow Coma Scale (GCS) of less than 13 were started on anti-epileptics as per the institute protocol. Patients were monitored for clinical seizure activity during the first seven days post-injury or until hospital discharge, whichever occurred first. Patients were classified according to the GCS score, mechanism of injury, CT findings, age, and sex. Results EPTS occurred in 29 (2.8%) of the 1,035 patients. Seizure incidence was highest in the severe TBI group (GCS 3-6: 5 (35.9%)), followed by moderate TBI (GCS 7-12: 11 (9.0%)), and mild TBI (GCS 13-15: 13 (1.5%)). Falls were the most common mechanism, with the highest seizure rate (15, 4.09%). The CT findings associated with the highest EPTS risk included brainstem contusion (1, 50%), subdural hemorrhage (8, 17.7%), and hemorrhagic contusion (7, 10%). The 0-10 age group had the highest absolute number of seizures (13, 6.2%). Male patients accounted for 76.7% (n=22) of the EPTS cases. Conclusions The incidence of EPTS in this study was 2.8%. The severity of TBI (p <0.001), a positive hemorrhagic finding in CT scan (p <0.001), and a younger age group (0-10 years) (p = 0.036) were statistically significantly associated with EPTS. These findings emphasize the need for targeted seizure surveillance and prophylaxis in high-risk TBI subgroups.