Two-Year Longitudinal and Prospective Electroencephalographic Follow-up in Patients with TBI: Can Early EEG and CT Findings Predict Post-Traumatic Epilepsy?

João Paulo João Paulo Santiago de Oliveira¹Viviam Sanabria Calvo²Carla Baise¹Rafael PS Valeriano¹Gustavo Mercenas Santos¹Natália Mata Longo¹Joaquina CQF Andrade¹Gesael Passos Ferreira Junior¹Carlos Andre Oshiro¹Claudia Costa Leite¹Maira Licia Foresti^2,3Luiz E Mello^2,3*Eliana Garzon¹

• ¹Hospital das Clinicas da FMUSP, SAO PAULO, Brazil
• ²Federal University of São Paulo, São Paulo, São Paulo, Brazil
• ³D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Rio de Janeiro, Brazil

Traumatic brain injury (TBI), caused by external force to the head, leads to anatomical or functional damage to cranial structures. It's a leading cause of morbidity and mortality in adults worldwide, with substantial economic burden. Post-traumatic epilepsy (PTE) is a significant complication of TBI, posing immense challenges to rehabilitation and exacerbating socioeconomic burdens. The incidence of PTE varies widely, underscoring the need for early detection and treatment. Objective: Through prospective electroencephalography (EEG) evaluations over a two-year period, our study aims to identify electrographic patterns indicative of PTE development, offering crucial insights for timely intervention and improved patient outcomes. Methods: Seventy-three adult participants with acute TBI, admitted to a reference hospital in Brazil between 2018-2020, were recruited based on eligibility criteria. EEG evaluations monitored seizure occurrence with follow-ups for up to 24 months post-TBI, though these were disrupted by the COVID-19 pandemic. Analyses included established EEG protocols, examining factors such as background activity and epileptiform paroxysms. Relative risk (RR), multiple correspondence analysis (MCA), logistic regression, and Generalized Estimating Equations (GEE) were employed to predict variables associated with PTE development. Results: Both PTE and NO-PTE (no post-traumatic epilepsy) patients showed improving background activity over two years. EEG recordings revealed that injuries in the temporal and temporo-parieto-occipital region, diffuse theta waves and abnormal bilateral sleep elements, and epileptiform paroxysms indicated a higher risk of PTE development. Additionally, multiple lesions were also associated with PTE. Conclusion: This comprehensive approach provides valuable insights for clinical management and sheds light on the complex interplay of factors influencing TBI outcomes.