Seizure Rates in Mild and Moderate Traumatic Brain Injury With Intracranial Hemorrhage: A Signal for Prospective Investigation of Seizure Prophylaxis in Moderate TBI

BACKGROUND: Post-traumatic seizures have been shown to occur in patients with traumatic brain injury (TBI). In cases of mild or moderate TBI there is a lack of evidence to guide the use of seizure prophylaxis. The purpose of this study is to characterize seizure rates among patients with mild and moderate TBI with intracranial hemorrhage (ICH) on computed tomography (CT), and to generate hypotheses regarding the potential role of seizure prophylaxis in this population. METHODS: This retrospective descriptive study included patients from a large Level I Trauma Center who were admitted with TBI between January 2019 and August 2021. Adult patients included were admitted with a diagnosis of mild or moderate TBI defined as a Glasgow Coma Scale (GCS) score of 9 or above with intracranial hemorrhage (ICH) on CT. The primary outcome was the incidence of suspected seizures or confirmed seizures within the first 7 days of injury. RESULTS: A total of 543 patients were included. 66.9% of patients were male with a mean age of 63 years. Mild TBI was predominantly represented (91.5%) with blunt trauma as the most common mechanism of injury (98.9%). Subdural hematomas were present in 64.8% of patients and subarachnoid hemorrhage in 53%. 41.4% of patients reported a history of alcohol use. Seizures were suspected in 6.2% of patients with mild TBI and confirmed in 3.6%. In moderate TBI, seizures were suspected in 23.9% and confirmed in 15.2%. CONCLUSION: These findings suggest a high seizure burden in moderate TBI (GCS 9-12) with ICH compared to mild TBI (GCS 13-15) with ICH, and support the need for prospective, risk-stratified trials to evaluate seizure prophylaxis in moderate TBI.