Risk factors for late post-traumatic epilepsy: Are they still reliable?

The usually accepted risk for late posttraumatic seizures (LPTS) are those identified years ago by Jennet: early posttraumatic seizures, depressed fractures, intracranial haematomas. Prolonged unconsciousness (PTA> 24) is another factor usually added. More recently personal experience of the Authors and the data of the literature induce to question the validity of known risk factors based on clinical data. Authors believe that the identification of patients at risk for LPTS depends mainly on the precise definition of trauma severity and on CT or surgically documented lesions of brain substance. Three groups of patients, characterized by the presence of one or more of the accepted risk factors of LPTS have been studied. According to our experience, while in adults the presence of documented cortico-subcortical lesions represents the main risk factor of LPTS, in children the appearance of EPTS per se increases the risk of LPTS. Alteration of consciousness without focal lesion, even if prolonged and severe, are not a risk factor of LPTS.