TBI neurological outcomes not affected by fluids
Investigators from the the Continuous Hyperosmolar Therapy for Traumatic Brain-Injured Patients (COBI) trial say the intervention does not lead to better neurological status compared to standard care.
Investigators randomised some 359 patients from six hospitals in France to receive either continuous infusion of 20% hypertonic saline solution within 24 hours after trauma on top of standard care or standard care alone.
But six months after the trauma the intervention, administered for a minimum of 48 hours, had not significantly shifted the distribution of GOS-E scores – the primary outcome – compared to the control group. However, confidence intervals for the findings were wide, and the study may have had limited power to detect a clinically important difference, they add.
Meanwhile, of the 12 secondary outcomes only two were significantly different between the groups:
Intracranial hypertension episodes occurred in 62 patients (33.7%) in the intervention group and 66 patients (36.3%) in the control group while moderate hypocapnia was induced in 11.5% of the patients in the intervention group and 5.5% in the control group.
Researchers say the intervention was associated with a lower risk of intracranial hypertension during the first 2 days, and a rebound of intracranial hypertension was apparent from day 4 onward. Discontinuation of the infusion of hypertonic solution may be an important step to prevent secondary brain injury, they suggested.
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Researchers identify delayed epilepsy diagnosis factors
A substantial proportion of individuals with newly diagnosed epilepsy report prior seizures, suggesting a missed opportunity for early epilepsy care and management, a new review shows.
Researchers in Melbourne who carried out a literature review from papers reporting delayed diagnoses between 1998 and 2020 say 75% of studies reported 38% or more patients affected by diagnostic delay. Delays of one year or more reported in 13-16% of cases.
Seizures prior to diagnosis were predominantly nonconvulsive, and usually more than one seizure was reported. But prior seizures were often missed or mistaken for symptoms of other conditions, they said. Misdiagnoses included dementia, hormonal issues, syncope, transient ischaemic attack, panic attacks, gastrointestinal disturbances, ischaemic heart disease, and in
children, breath-holding, and family or behavioural issues.
Meanwhile the review identified some studies that showed none of the patients who had previous seizures had a referral letter that included a comment on the events.
The review also highlights potential risk factors for referral delay that includes socioeconomic variables, parent education levels and race and ethnicity – factors that may influence the ability or confidence of patients to discuss their new experiences and symptoms in a way that makes the events recognisable for primary health care physicians.
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Corticectomy surgery effective for control of seizures
One-stage, limited corticectomy for bottom-of-sulcus dysplasia (BOSD) is safe and effective for control of seizures, a Victorian study has shown
Some 38 patients with MRI-positive BOSD underwent corticectomy guided by MRI and electrocorticography (ECoG) at The Royal Children’s Hospital, Parkville in Victoria.
While six patients required reoperation for postoperative seizures and residual dysplasia investigators led by paediatric neurologist Dr Simon Harvey said reoperation was not correlated with ECoG, neuroimaging or histological abnormalities in the gyral crown.
At median 6.3 years follow-up, 33 (87%) patients are seizure-free and 31 are off antiseizure medication, they report.
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