Incidence and predictors of posttraumatic epilepsy and cognitive impairment in patients with traumatic brain injury: A retrospective cohort study in Malaysia

Objective: Posttraumatic epilepsy (PTE) significantly impacts morbidity and mortality, yet local PTE data remain scarce. In addition, there is a lack of evidence on cognitive comorbidity in individuals with PTE in the literature. We sought to identify potential PTE predictors and evaluate cognitive comorbidity in patients with PTE. Methods: A 2-year retrospective cohort study was employed, in which adults with a history of admission for traumatic brain injury (TBI) in 2019 and 2020 were contacted. Three hundred one individuals agreed to participate, with a median follow-up time of 30.75 months. The development of epilepsy was ascertained using a validated tool and confirmed by our neurologists during visits. Clinical psychologists assessed the patients’ cognitive performance. Results: The 2-year cumulative incidence of PTE was 9.3% (95% confidence interval [CI] 5.9–12.7). The significant predictors of PTE were identified as a previous history of brain injury [hazard ratio [HR] 4.025, p =.021], and intraparenchymal hemorrhage (HR: 2.291, p =.036), after adjusting for other confounders. TBI patients with PTE performed significantly worse on the total ACE-III cognitive test (73.5 vs 87.0, p =.018), CTMT (27.5 vs 33.0, p =.044), and PSI (74.0 vs 86.0, p =.006) than TBI patients without PTE. A significantly higher percentage of individuals in the PTE group had cognitive impairment, compared to the non-PTE group based on ACE-III (53.6% vs 46.4%, p =.001) and PSI (70% vs 31.7%, p =.005) scores at 2 years post-TBI follow-up. Significance: This study emphasizes the link between TBI and PTE and the chance of developing cognitive impairment in the future. Clinicians can target interventions to prevent PTE by identifying specific predictors, which helps them make care decisions and develop therapies to improve patients’ quality of life.