[en] Epileptic seizures/post-traumatic epilepsy (ES/PTE) are frequent in persons with brain injuries, particularly for patients with more severe injuries including ones that result in disorders of consciousness (DoC). Surprisingly, there are currently no best practice guidelines for assessment or management of ES in persons with DoC. This study aimed to identify clinician attitudes toward epilepsy prophylaxis, diagnosis and treatment in patients with DoC as well as current practice in regards to the use of amantadine in these individuals. A cross-sectional online survey was sent to members of the International Brain Injury Association (IBIA). Fifty physician responses were included in the final analysis. Withdrawal of antiepileptic drug/anti-seizure medications (AED/ASM) therapy was guided by the absence of evidence of clinical seizure whether or not the AED/ASM was given prophylactically or for actual seizure/epilepsy treatment. Standard EEG was the most frequent diagnostic method utilized. The majority of respondents ordered an EEG if there were concerns regarding lack of neurological progress. AED/ASM prescription was reported to be triggered by the first clinically evident seizure with levetiracetam being the AED/ASM of choice. Amantadine was frequently prescribed although less so in patients with epilepsy and/or EEG based epileptic abnormalities. A minority of respondents reported an association between amantadine and seizure. Longitudinal studies on epilepsy management, epilepsy impact on neurologic prognosis, as well as potential drug effects on seizure risk in persons with DoC appear warranted with the goal of pushing guideline development forward and improving clinical assessment and management of seizures in this unique, albeit challenging, population.
Disciplines :
Neurology
Author, co-author :
Briand, Marie-Michèle; Coma Science Group, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA) Consciousness, University of Liège, Liège, Belgium ; Centre du Cerveau, University Hospital of Liège, Liège, Belgium ; Physical Medicine and Rehabilitation Department, Institut de Réadaptation en Déficience Physique de Québec, Quebec, QC, Canada ; Research Center of the Sacré-Coeur Hospital of Montreal, Montreal, QC, Canada
Lejeune, Nicolas ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group ; DoC Care Unit, Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium ; Institute of NeuroScience, UCLouvain, Brussels, Belgium
Zasler, Nathan; Concussion Care Centre of Virginia, Ltd., Richmond, VA, United States ; Tree of Life Services Inc., Richmond, VA, United States ; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
Formisano, Rita; IRCCS, Santa Lucia Foundation, Rome, Italy
Bodart, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > > Service de neurologie
Estraneo, Anna; Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Don Carlo Gnocchi, Florence, Italy ; Neurology Unit, Santa Maria della Pietà General Hospital, Nola, Italy
Magee, Wendy L; Boyer College of Music and Dance, Temple University, Philadelphia, PA, United States
Thibaut, Aurore ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group
Language :
English
Title :
Management of Epileptic Seizures in Disorders of Consciousness: An International Survey.
M-MB would like to thank the Université Laval (Québec, Canada) for their financial support as she received the McLaughlin award, the Canadian Institute of Health Research (CIHR) and the Fonds de Recherche du Québec-Santé (FRQ-S). All authors thank the University and University Hospital of Liege, the Belgian National Funds for Scientific Research (FRS-FNRS), the European Union’s Horizon 2020 Framework Programme for Research and Innovation under the Specific Grant Agreement No. 785907 (Human Brain Project SGA2), the Luminous project (EU-H2020-fetopenga686764), the European Space Agency (ESA) and the Belgian Federal Science Policy Office (BELSPO) in the framework of the PRODEX Programme, the Center-TBI project (FP7-HEALTH-602150), the Public Utility Foundation Université Européenne du Travail, Fondazione Europea di Ricerca Biomedica, the Bial Foundation, the Mind Science Foundation and the European Commission, the fund Generet, the King Baudouin Foundation, the Mind-Care foundation, DOCMA project (EU-H2020-MSCA–RISE−778234). AT is Research Associate and NL a Post-Doctoral Researcher at the FNRS.
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