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Abstract：
BACKGROUND: Posttraumatic epileptic seizures (PTS) are a serious complication in patients with subdural haematoma (SDH). However, to date, several studies have shown discordances about SDH-associated seizures in terms of incidence, risk factors and prophylactic antiepileptic treatment.
OBJECTIVE: The aim of this study was to analyse the incidence, risk factors of PTS and the role of prophylactic antiepileptic treatment in patients with SDH.
METHODS: A systematic literature review examining PTS in patients with SDH was performed using PubMed gateway, Cochrane Central Register of Controlled Trials, and Excerpta Medica dataBASE between September 1961 and February 2016. Search terms included subdural haematoma, seizure, epilepsy, prophylactic antiepileptic drugs, anticonvulsive medication, and risk factors.
METHODS: Human-based clinical studies focusing on epileptic seizures in patients with SDH.
METHODS: PRISMA statements were used for assessing data quality. Two independent reviewers extracted data from included studies and disagreement was solved by consensus. Twenty-four studies were identified for inclusion into the study.
RESULTS: Overall incidence of early PTS (ePTS) and late PTS (lPTS)/2 years was 28% and 43% in acute SDH (aSDH) whereas the incidence of e- and lPTS was lower in chronic SDH (cSDH; 5.3% vs. 10%). Overall risk factors for PTS in patients with aSDH were: 24h postoperative Glasgow Coma Score (GCS) score below 9 (OR 10.5), craniotomy (OR 3.9), preoperative GCS below 8 (OR 3.1). In patients with cSDH the risk factors were alcohol abuse (OR 14.3), change of mental status (OR 7.2), previous stroke (OR 5.3) and density of haematoma in computer tomography (OR 3.8). Age, sex, haematoma size/side and midline shifts were not significant risk factors for PTS in both types of SDH. In prevention of PTS phenytoin and levetiracetam showed similar efficacy (OR 1.3), whereas levetiracetam was associated with significantly lower adverse effects (OR 0.1).
CONCLUSIONS: Most of the studies were of retrospective nature with a small sample size. Due to the inclusion criteria, some studies had to be excluded and that might lead to selection bias.
CONCLUSIONS: PTS are a serious complication in patients with SDH, particularly in aSDH. The \"prophylactic use\" of antiepileptic drugs might be beneficial in patients with cumulative risk factors.
OBJECTIVE: The aim of this study was to analyse the incidence, risk factors of PTS and the role of prophylactic antiepileptic treatment in patients with SDH.
METHODS: A systematic literature review examining PTS in patients with SDH was performed using PubMed gateway, Cochrane Central Register of Controlled Trials, and Excerpta Medica dataBASE between September 1961 and February 2016. Search terms included subdural haematoma, seizure, epilepsy, prophylactic antiepileptic drugs, anticonvulsive medication, and risk factors.
METHODS: Human-based clinical studies focusing on epileptic seizures in patients with SDH.
METHODS: PRISMA statements were used for assessing data quality. Two independent reviewers extracted data from included studies and disagreement was solved by consensus. Twenty-four studies were identified for inclusion into the study.
RESULTS: Overall incidence of early PTS (ePTS) and late PTS (lPTS)/2 years was 28% and 43% in acute SDH (aSDH) whereas the incidence of e- and lPTS was lower in chronic SDH (cSDH; 5.3% vs. 10%). Overall risk factors for PTS in patients with aSDH were: 24h postoperative Glasgow Coma Score (GCS) score below 9 (OR 10.5), craniotomy (OR 3.9), preoperative GCS below 8 (OR 3.1). In patients with cSDH the risk factors were alcohol abuse (OR 14.3), change of mental status (OR 7.2), previous stroke (OR 5.3) and density of haematoma in computer tomography (OR 3.8). Age, sex, haematoma size/side and midline shifts were not significant risk factors for PTS in both types of SDH. In prevention of PTS phenytoin and levetiracetam showed similar efficacy (OR 1.3), whereas levetiracetam was associated with significantly lower adverse effects (OR 0.1).
CONCLUSIONS: Most of the studies were of retrospective nature with a small sample size. Due to the inclusion criteria, some studies had to be excluded and that might lead to selection bias.
CONCLUSIONS: PTS are a serious complication in patients with SDH, particularly in aSDH. The \"prophylactic use\" of antiepileptic drugs might be beneficial in patients with cumulative risk factors.
摘要：
背景：外伤性癫痫发作（PTS）是硬膜下血肿（SDH）患者的严重并发症。然而,到目前为止,几项研究表明，SDH相关的癫痫发作在发病率方面存在差异，危险因素和预防性抗癫痫治疗。
目的：本研究的目的是分析发病率，PTS的危险因素和预防性抗癫痫治疗在SDH患者中的作用。
方法：使用PubMed网关对SDH患者的PTS进行了系统文献综述，Cochrane中央控制试验登记册,和ExcerptaMedicadataBASE在1961年9月至2016年2月之间。搜索词包括硬膜下血肿，癫痫发作,癫痫,预防性抗癫痫药物，抗惊厥药物,和风险因素。
方法：针对SDH患者癫痫发作的基于人类的临床研究。
方法：PRISMA语句用于评估数据质量。两名独立审稿人从纳入的研究中提取数据，并通过共识解决了分歧。确定了24项研究纳入研究。
结果：在急性SDH（aSDH）中，早期PTS（ePTS）和晚期PTS（lPTS）/2年的总发生率分别为28％和43％，而e和lPTS的发生率在慢性SDH中更低（cSDH；5.3％vs.10%)。aSDH患者PTS的总体危险因素是：术后24h格拉斯哥昏迷评分（GCS）低于9分（OR10.5），开颅术（或3.9），术前GCS低于8（OR3.1）。在cSDH患者中，危险因素是酒精滥用(OR14.3)，精神状态变化（OR7.2），既往卒中（OR5.3）和计算机断层扫描中的血肿密度（OR3.8）。年龄,性别,在两种类型的SDH中,血肿大小/侧位和中线移位均不是PTS的显著危险因素.在预防PTS苯妥英和左乙拉西坦有相似的疗效（OR1.3），而左乙拉西坦的不良反应显著降低(OR0.1).
结论：大多数研究是回顾性的，样本量小。由于纳入标准，一些研究不得不排除,这可能导致选择偏倚.
结论：PTS是SDH患者的严重并发症，特别是在ASDH中。抗癫痫药物的“预防性使用”可能对具有累积危险因素的患者有益。
目的：本研究的目的是分析发病率，PTS的危险因素和预防性抗癫痫治疗在SDH患者中的作用。
方法：使用PubMed网关对SDH患者的PTS进行了系统文献综述，Cochrane中央控制试验登记册,和ExcerptaMedicadataBASE在1961年9月至2016年2月之间。搜索词包括硬膜下血肿，癫痫发作,癫痫,预防性抗癫痫药物，抗惊厥药物,和风险因素。
方法：针对SDH患者癫痫发作的基于人类的临床研究。
方法：PRISMA语句用于评估数据质量。两名独立审稿人从纳入的研究中提取数据，并通过共识解决了分歧。确定了24项研究纳入研究。
结果：在急性SDH（aSDH）中，早期PTS（ePTS）和晚期PTS（lPTS）/2年的总发生率分别为28％和43％，而e和lPTS的发生率在慢性SDH中更低（cSDH；5.3％vs.10%)。aSDH患者PTS的总体危险因素是：术后24h格拉斯哥昏迷评分（GCS）低于9分（OR10.5），开颅术（或3.9），术前GCS低于8（OR3.1）。在cSDH患者中，危险因素是酒精滥用(OR14.3)，精神状态变化（OR7.2），既往卒中（OR5.3）和计算机断层扫描中的血肿密度（OR3.8）。年龄,性别,在两种类型的SDH中,血肿大小/侧位和中线移位均不是PTS的显著危险因素.在预防PTS苯妥英和左乙拉西坦有相似的疗效（OR1.3），而左乙拉西坦的不良反应显著降低(OR0.1).
结论：大多数研究是回顾性的，样本量小。由于纳入标准，一些研究不得不排除,这可能导致选择偏倚.
结论：PTS是SDH患者的严重并发症，特别是在ASDH中。抗癫痫药物的“预防性使用”可能对具有累积危险因素的患者有益。
