Publications
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Sødal, Hild Flatmark; Nordseth, Trond; Rasmussen, Anders Johan Orland; Rosseland, Leiv Arne; Stenehjem, Jo & Gran, Jon Michael
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(2024).
Risk of epilepsy after traumatic brain injury: a nationwide Norwegian matched cohort study.
Frontiers in Neurology.
15.
doi:
10.3389/fneur.2024.1411692.
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Background: Post-traumatic epilepsy (PTE) is a well-known complication of traumatic brain injury (TBI). Although several risk factors have been identified, prediction of PTE is difficult. Changing demographics and advances in TBI treatment may affect the risk of PTE. Our aim was to provide an up-to-date estimate of the incidence of PTE by linking multiple nationwide registers.
Methods: Patients with TBI admitted to hospital 2015-2018 were identified in the Norwegian Trauma Registry and matched to trauma-free controls on sex and birth year according to a matched cohort design. They were followed up for epilepsy in nationwide registers 2015-2020. Cumulative incidence of epilepsy in TBI patients and controls was estimated taking competing risks into account. Analyses stratified by the Abbreviated Injury Scale (AIS) severity score, Glasgow Coma Scale score and age were conducted for the TBI group. Occurrence of PTE in different injury types was visualized using UpSet plots.
Results: In total, 8,660 patients and
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Sødal, Hild Flatmark; Storvig, Gøril; Tverdal, Cathrine Buaas; Robinson, Hilde Stendal; Helseth, Eirik & Taubøll, Erik
(2022).
Early post-traumatic seizures in hospitalized patients with traumatic brain injury.
Acta Neurologica Scandinavica.
ISSN 0001-6314.
146(5),
p. 485–491.
doi:
10.1111/ane.13670.
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Objectives Early post-traumatic seizures (EPTS) are a well-known complication of traumatic brain injury (TBI). EPTS increase the risk of secondary brain injury and may cause significant challenges during the period of critical care. Routine use of prophylactic anti-seizure medication is controversial due to conflicting reports on efficacy and risk of adverse effects. The purpose of this study was to expand the understanding of EPTS by examining incidence and risk factors in hospitalized patients with TBI. Material & Methods Adult patients with TBI and evidence of intracranial injury admitted to Oslo University Hospital between 2015 and 2019 were identified from the Oslo TBI Registry - Neurosurgery. Demographic and clinical data including occurrence of seizures were retrieved from the registry. The patients did not receive routine seizure prophylaxis. Univariate and multivariable logistic regression analyses were used to investigate risk factors associated with EPTS. Results 103 of 1827 patients (5.6%) had new-onset seizures within the first week after TBI. The following factors were in multivariable analyses associated with EPTS; alcohol abuse (odds ratio [OR] 3.6, 95% CI 2.3–5.7, p < .001), moderate and severe brain injury (OR 2.2, 95% CI 1.3–3.8, p = .004 and OR 2.1, 95% CI 1.2–3.6, p = .012), brain contusion (OR 1.6, 95% CI 1.0–2.4, p = .046) and subdural hematoma (OR 1.6, 95% CI 1.0–2.6, p = .052). Conclusion In our material, EPTS occurred in 5.6% of hospital-admitted TBI-patients. Alcohol abuse was the most significant risk factor, followed by moderate and severe brain injury. The results of this study contribute to the discussion about preventive treatment of EPTS in certain risk groups.
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Lossius, Ida Marie Bakke; Svendsen, Torleiv; Sødal, Hild Flatmark; Kjeldstadli, Kari Grandaunet; Lossius, Morten Ingvar & Nakken, Karl Otto
[Show all 7 contributors for this article]
(2021).
Effect and tolerability of perampanel in patients with drug-resistant epilepsy.
Epilepsy & Behavior.
ISSN 1525-5050.
119.
doi:
10.1016/j.yebeh.2021.107965.
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Objective: Perampanel is one of the most recently approved antiseizure medications. The aim of the present study was to assess clinical efficacy and tolerability, in combination with pharmacokinetic variability, of perampanel treatment in patients at a tertiary referral center for epilepsy.
Methods: We performed a retrospective observational study of patients given perampanel as adjunctive treatment in the period January 2013 - February 2019 at the National Center for Epilepsy at Oslo University Hospital, Norway.
Results: Clinical data were available for 175 mainly adult patients with drug-resistant epilepsy with mean treatment duration of 16.1 months. We found that 23% (40 patients) were responders (i.e., achieving more than 50% reduction in seizure frequency), four of whom became seizure free, 29% (51 patients) experienced a modest effect, whereas for 29% (50 patients) perampanel had no seizure-reducing effect. A paradoxical effect, with seizure aggravation, was reported in 9% (15 patients). The responder rate was significantly higher in those with slow vs. fast dosage titration. Logistic regression analysis showed better efficacy among those with generalized vs. those with focal epilepsy. Adverse effects were reported by 135 patients (77%), ranging from mild (34%), to moderate (41%) and severe (2%). In 55 patients (41%), these adverse effects resulted in discontinuation of treatment with perampanel. The most frequent adverse effects were psychiatric symptoms (34%), dizziness (31%), and sleepiness (26%). Of the 31 patients for whom serum concentration measurements were available, the mean daily perampanel dose was 6.3 mg (SD 3.0), with a mean serum concentration at steady state of 1.03 μmol/L (range: 0.15-3.59 μmol/L). There were pronounced differences between patients, as demonstrated by a 12-fold variability in the range of concentration/dose (C/D)-ratios (0.06 to 0.69 μmol/L/mg), where enzyme inducers contributed.
Conclusion: Our results demonstrate that perampanel had a modest seizure-reducing effect in this very treatment-resistant patient group. Predictors of treatment success were generalized epilepsy and slow dosage titration. In patients without a history of psychiatric problems, clinicians could consider increasing dose of perampanel beyond 6 mg daily, taking co-medication and serum concentrations into account.
Keywords: Antiseizure medications drugs; Serum concentrations; Therapeutic drug monitoring.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Storvig, Gøril; Sødal, Hild Flatmark; Robinson, Hilde Stendal; Tverdal, Cathrine Buaas; Helseth, Eirik & Taubøll, Erik
(2022).
Tidlig post-traumatiske epileptiske anfall hos pasienter med traumatisk hjerneskade.
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Published
Jan. 8, 2021 3:00 PM
- Last modified
Sep. 2, 2022 1:41 PM
