Posttraumatic epilepsy is result of head trauma. The aim of our research was to establish how many patients after head trauma developed posttraumatic epilepsy (PTE). Retrospectively we analyzed 50 patients with head trauma different severity in period from 1989. to 2008., which we werified radiological, electroenfephalographic, and psychical changes were established according pto psychiatric examination. From 50 patient with head trauma, 40 developed seizures (3 in the firs 24 hours and 6 after first 24 hours to the end of first week, 31 after first week). By introducing antiepileptic therapy (AETh), 30 patients were seizure free, 10 patients had 1-2 epileptic seizure monthly (EPA/CPA), 10 patients got prophylactic AETh in period 6-12 months. 14 patients developed psychical changes which were verified by psychiatrist. The experience and literature show that posttraumatic epilepsy is good for treating with 1 or 2 antiepileptic, and remission is more difficult in case psychiatric comorbidity

Gordana Lojen

Lidija Šapina

Vladimira Vuletić

Željka Janjetović

Željka Vuković-Arar

English

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Coll. Antropol. 38 (2014) 3: 1077–1079Professional paperHead Trauma and Posttraumatic Epilepsy inSlavonski Brod, East Croatia, 1988–2008Lidija [apina1, Vladimira Vuleti}1, Gordana Lojen1, @eljka Janjetovi}2 and @eljka Vukovi}-Arar21 »Dr. Josip Ben~evi}« General Hospital, Department for Neurology, Slavonski Brod, Croatia2 »Dr. Josip Ben~evi}« General Hospital, Department for Ophtalmology, Slavonski Brod, CroatiaA B S T R A C TPosttraumatic epilepsy is result of head trauma. The aim of our research was to establish how many patients afterhead trauma developed posttraumatic epilepsy (PTE). Retrospectively we analyzed 50 patients with head trauma differ-ent severity in period from 1989. to 2008., which we werified radiological, electroenfephalographic, and psychical chan-ges were established according pto psychiatric examination. From 50 patient with head trauma, 40 developed seizures (3in the firs 24 hours and 6 after first 24 hours to the end of first week, 31 after first week). By introducing antiepileptictherapy (AETh), 30 patients were seizure free, 10 patients had 1–2 epileptic seizure monthly (EPA/CPA), 10 patients gotprophylactic AETh in period 6–12 months. 14 patients developed psychical changes which were verified by psychiatrist.The experience and literature show that posttraumatic epilepsy is good for treating with 1 or 2 antiepileptic, and remis-sion is more difficult in case psychiatric comorbidity.Key words: epilepsy, Croatia, prognosis, trauma, therapyIntroductionHead trauma is one of the causes of symptomaticposttraumatic epilepsy (PTE), and risk of PTE dependson severity of head trauma, but on genetic predisposi-tion, too. Head traumas are divided into opened (duradamaged) and closed (dura not damaged).Traditionally, posttraumatic seizures are: immediate,early and late. Immediate occurs in first 24 hours fromhead trauma, early between first 24 hours until the endof the first week, and the late after the first week of headtrauma1. Closed head trauma mostly happen in civilian-peace circumstances, in traffic accidents, by falling, dur-ing making sport and recreation.Mild trauma is defined as head trauma with loss ofconscious or posttraumatic amnesia less than 30 min.,without skull fracture, and is not associated with greaterrisk for PTE. Moderate head trauma is associated withloss of conscious or posttraumatic amnesia longer than30 min, without skull fracture, with risk for PTE 1–4%1.Severe head trauma is associated with loss of consciousor posttraumatic amnesia longer than 24 hours, withskull fracture and/or intracranial bleeding or cerebralcontusion, with risk for PTE 10–15%1.The risk for epileptic seizures is the greatest duringthe first year after head trauma, with most frequency4–8 months after trauma, and will be lower in the follow-ing years. After 10 years only severe traumas are stillrisk for PTE1. Posttraumatic epilepsy is more frequentafter open head injury, for example penetrating traumas,especially front and temporal brain region1–8.Patophysiological changes of posttraumatic etiologyare complex. The kinetic energy is transferred duringtrauma to brain tissue, produces pressure which disruptthe brain tissue and lead to hystopatological changes, in-cluding: gliosis, axonal retractive changes, Wallerian de-generation and cystic white matter lesions. Iron releasedfrom hemoglobin generated free radicals which destroycell membrane, cause intracellular calcium oscillation5–12.Hippocampal damage leeds to secondary excitability dueto the death oft he inhibitory dentate hilar neurons.Hyperexcitability during some months can leed to reor-ganisation of excitatory pathways (mossy fibre sprout-ing) and development of refractory epilepsy. The riskgrowth with positive family anamnesis for epilepsy. The-re are still existing controversis concerning prophylactic1077Received for publication December 14, 2010application of antiepileptic drugs after head trauma.They use obligatory if immediate or early seizure occurs,even they have no influence on late posttraumatic epilep-tic seizures (PTE) – do not reduce the risk13–21. Thatmeans, in a latent period between head trauma and de-velopment of PTE, duration months or longer, epilepto-genesis can occure¸8–21.Patients and MethodsOur research was retrospectivelly. From 1000 regis-tered epileptic patients in ambulance from SlavonskiBrod and closer area, which include 130 000 citizens, 50patients had head trauma different severity. From 50 pa-tients, 45 were men and 5 women in age 18–71 years, 4mean 42.3 years. Patients were followed from 1988–2008. Head traumas were more frequent in the periodfrom 1991–1996. During Homeland war and mostly in-jured were Croatian soldier, men in age 19–39 years,mean 22.4 years. We analyzed: the severity of headtrauma, the time between trauma and epileptic seizure,type of the seizure, number of seizures before and afteradministration antiepileptic therapy, number of adminis-tered antiepileptic drugs, psychical changes.ResultsConcerning type of head trauma, they occurred: mildbrain trauma in 17 patients (34%), moderate in 12 pa-tients (24%), severe head trauma in 21 patients (42%)(Figure 1). In period from 1988–1997 happened 36 trau-mas, mostly in war circumstances in our area 1991–1996,from 1998–2007 14 traumas (28%). Concerning the timebetween head trauma and epileptic seizure: 3 patients(6%)developed seizure in first 24 hours-immediate, 6 pa-tients (12%) developed seizures in time between 24 hoursand the end of first week of trauma-early, and 31 (62%)patients developed seizures after first week-late. Late ep-ileptic seizure we analyzed according time of developfirst epileptic seizure: in first year after trauma 11 pa-tients (22%), in second year after trauma 5 patients(10%), from 3–5 years after trauma 7 patients (14%),from 6–10 years after trauma 5 patients (10%), after 10years 3 patients (6%) from total number of patients withhead trauma. 10 patients (20%) were without seizure af-ter head trauma (Figure 2).According to the type of seizure: generalized tonic--klonic attacks (GTKA) we found in 16 patients (32%),complex partial seizure with second generalization in 10patients (20%), complex partial seizures (CPA) in 7 pa-tients (16%), elementary partial seizures with secondgeneralization in 4 patients (14%), elementary partialseizures(EPA) in 2 patients (6%), EPA which evolving inCPA in 1 patient (2%) (Figure 3).The number of seizure before introducing antiepi-leptic were 1–10 different seizure, and after introducingantiepileptic were 1–2 EPA/CPA in 10 patients.Number of epileptic seizure before antiepileptic ther-apy was 1–10, after introduction of antiepileptic therapyare rare, in 5-years interval, on 1–2 EPS/ CPS monthly in10 patients, from which 8 patients had psychiatric co-morbidity, others were without seizures. 10 patients af-ter CCI did not nave seizures. Prophylactic antiepileptictherapy applied in 10 patients 6 months – 1 year, withoutlate seizure event.According the number of antiepileptic: monotherapywas in 21 patients (42%), two antiepileptics in 17 pa-tients (34%), three in 2 patients (4%).Psychic changes: 10 patients developed depressivedisorder (20%), 3 patients psychosis (6%), 1 became ad-dicted to narcotics (2%).Discussion and ConclusionPTE is a serous problem for epileptic patients and hisfamilies, because of many limitations and influence onquality of life: limitations by employment, dependenceabout parents, loss of social contacts, no driving license.The similar experiences we found in study with Viet-nam war veterans, in war Iraq-Iran, etc.8–15. HigherL. [apina et al.: Head Trauma and Posttraumatic Epilepsy, Coll. Antropol. 38 (2014) 3: 1077–10791078171221Mild brain traumaModerate head traumaSever head traumaFig. 1. Types of head traumas.Time between trauma and seizure024681012Immediate In 1st weekearrlyFrom 2ndweek- theend of 1styearIn 2nd year From 3-5yearFrom 6-10yearAfter 10yearsNumber of patientsFig. 2. Time between trauma and seizure.39%25%18%10%5% 3%GTKAComplex partial attacks +secondary generalisationCPAElementar partial attacks (EPA)+secondary generalisationElementar partial attacks(EPA)Elementar partial attacks (EPA) evolutinginComplex partial attacks (CPA)Fig. 3. Types of seizures.number of head traumas were between 1991–1996 we ex-plain by traumas during of Homeland war.Posttraumatic epilepsies responding well to treatment,usually one or two antiepileptics, with more difficult re-mission in case psychiatric comorbidity.AcknowledgementsWe thank to our colleagues who helped us in diagnos-tic and therapy epileptic patients, as well as to all pa-tients and families of patients for cooperation, withoutthis work would be impossible.R E F E R E N C E S1. SHORVON SD Handbook of epilepsy treatment (Blackwell pub-lishing, Oxford, 2005. — 2. RAYMONT V, SALAZAR AM, LIPSKY R,GOLDMAN D, TASICK G, PA, GRAFMAN J, Neurology 75 (2010) 224. —3. MAZINI L, MARIA COSSA F, ANGELINO E, CAMPINI R, PASTOREI, MONACO F, Epilepsia, 44 (2003) 569. — 4. FREY CL, Epilepsia, 44(2003) 11. — 5. GARGA N, LOWENSTEIN HD, Epilepsy Curr, 6 (2006) 1.— 6. GALLAGHER D, Einstein Quart J Biol Med, 19 (2002) 5. — 7. MO-RI A, YOKOI I, NODA Y, WILLMORE J, Acta Med Okayama, 58 (2004)111. — 8. BEGHI E, Epilepsia, 44 (2003) 21. — 9. INABA K, MENAKERJ, BRANCO CB, GOOCH J, OKOYE TO, HERROLD J, Trauma AcuteCare Surg, 74 (2010) 766. — 10. KELLETT WM, SMITH FD, STOCKONAP, CHADWICK WD, J Neurol Neurosurg Psychyatry, 66 (1999) 759. —11. JONES EK, PUCCIO AM, HARSHMAN HJ, FALCIONE B, BENE-DICT N, JANKOWITZ BT, Neurosurg Focus, 25 (2008) 1. — 12. DIAZ--ARRASTIA R, AGOSTINI AM, MADDEN JC, VAN NESS CP, Epilepsia,50 (2009) 14. — 13. KHARATISHVILI I, PITKANEN A, Curr Opin Neu-rol, 23 (2010) 183. — 14. WILLMORE LJ, Epilepsy Curr, 12 (2012) 87. —15. KAPIDZIC A, VIDOVIC M, SINANOVIC O, Med Arh, 65 (2011) 343.— 16. TIMOFEEV I, BAZENHOV M, AVRAMESCU S, NITA AD, Neuro-scientist, 16 (2010) 19. — 17. LOWENSTEIN HD, Epilepsia, 50 (2009) 4.— 18. [EPI]-GRAHOVAC D, GRAHOVAC T, RU@I]-BAR[I] A, RU@I]K, DADI]-HERO E, Psychiatria Danubina, 23 (2011) 111. — 19. KLEINP, HERR D, PEARL PL, NATALE J, LEVINE Z, NOGAY C, Arch Neurol,69 (2012) 1290. — 20. MARSON GA, AL-KHARUSI MA, ALWAIDH M,APPLETON R, BAKER AG, CHADWICK WD, Lancet, 369 (2007) 1000.— 21. HAJN[EK S, Neurol Croat, 59 (2010) 5.L. [apinaGeneral Hospital »Dr. Josip Ben~evi}«, Department for Neurology, Andrije [tampara 42, 35000 Slavonski Brod, Croatiae-mail: lsapina@.net.hrTRAUMA GLAVE I POSTTRAUMATSKA EPILEPSIJA U SLAVONSKOM BRODU,ISTO^NA HRVATSKA, 1988.–2008.S A @ E T A KPosttraumatska epilepsija je posljedica ozljede glave. Cilj na{eg istra`ivanja bio je utvrditi koliko je bolesnika izlo`e-nih traumi glave razvilo posttraumatsku epilepsiju. Retrospektivno smo analizirali 50 bolesnika sa do`ivljenom trau-mom glave razli~itog intenziteta u razdoblju od 1988–2008. godine, koju smo verificirali radiolo{ki, elektroencefalo-grafski, a psihi~ke promjene psihijatrijskim pregledom. Od 50 traumatiziranih bolesnika, 40 je razvilo napadaje (3 uprvih 24 sata, 6 od prvih 24 sata-prvih tjedan dana, 31 nakon prvog tjedna). Uvo|enjem antiepilepti~ke terapije 30bolesnika bilo je bez napadaja, 10 bolesnika imalo je 1–2 napadaja mjese~no (EPA/CPA). 10 bolesnika uzimalo je anti-epilepti~ku terapiju 6–12 mjeseci nakon do`ivljene traume glave. 14 bolesnika razvilo je psihi~ke promjene verificiraneod strane psihijatra. Iskustvo i literatura pokazuju nam da je posttraumatska epilepsija dobra za lije~enje, uglavnom uz1 ili 2 antiepileptika, uz te`e postizanje remisije u slu~aju psihijatrijskog komorbiditeta.L. [apina et al.: Head Trauma and Posttraumatic Epilepsy, Coll. Antropol. 38 (2014) 3: 1077–10791079

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