Characterization of acute post-craniectomy seizures in traumatically brain-injured patients

• Acute post-craniectomy seizures are common in traumatic patients.
• Seizures occur mostly within the first 3 days following craniectomy.
• The hospital stay is significantly longer for seizure patients.
• Neurological outcome and mortality rate are not affected by seizures.

PurposeDecompressive craniectomy (DC) is a life-saving measure for traumatic brain injury (TBI), but acute seizures following this procedure may have a devastating effect. We aim to investigate the clinical characteristics of acute post-craniectomy seizures.MethodsFor this retrospective study, we enrolled 195 patients undergoing DC for TBI. Acute post-craniectomy seizure was defined as seizures occurring within 7 days of DC.ResultsThe incidence of acute seizure was 10.8% (21/195). 19 of 21 seizures occurred within 3 days following DC. None progressed to status epilepticus, but 16 of 21 patients (76.2%) with acute seizure developed epilepsy. There was no independent risk factor in the multivariate regression model. The mean hospital stay was 44.8 ± 34.6 and 28.8 ± 32.3 days for patients with and without acute seizures, respectively (p = 0.035). The neurological outcome at discharge showed no inter-group difference (p = 0.917). The in-hospital mortality rate was 28.6% for patients with seizures and 31.0% for patients without seizures (p = 0.817).ConclusionAcute seizures occur mostly within the first 3 days following DC. Neurological outcome and mortality rate at discharge does not differ between patients with or without seizures, but the duration of hospital stay is significantly longer for acute seizure patients.