Aktuelle Neurologie 2007; 34(10): 559-563
DOI: 10.1055/s-2007-986200
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Epilepsien durch intrazerebrale Schussverletzungen

Epileptic Seizures Due to Penetrating Gun-Shot Injury of the HeadM.  Bös1 , J.  Bauer2
  • 1Neurochirurgische Klinik, Universitätsklinikum Bonn
  • 2Klinik für Epileptologie, Universitätsklinikum Bonn
Further Information

Publication History

Publication Date:
07 December 2007 (online)

Zusammenfassung

Schussverletzungen sind als ziviles Trauma eine seltene Ursache einer symptomatischen Epilepsie. Wir berichten über drei Patienten, die infolge einer Schussverletzung eine Epilepsie entwickelten. Die Schüsse erfolgten im Ehestreit, durch eine versuchte Tötung und als Unfall. Zwei Patienten erlitten Spätanfälle (ab Tag 8 nach der Verletzung), ein Patient Frühanfälle. Bei zwei Patienten verblieben Metallteile intrazerebral. Bei allen drei Patienten gestaltete sich die antikonvulsive Therapie effizient. Im Gegensatz zu militärischen Kopfverletzungen, die sich oft auch als penetrierende Schussverletzungen darstellen, ist die zivile Kopfverletzung offenbar mit einer deutlich günstigeren Behandlungsprognose verbunden.

Abstract

Trauma due to penetrating gun-shot injury of the head in the civilian population is a rare cause for post-traumatic epilepsy. The following report concerns three patients who developed epileptic seizures due to a civilian penetrating gun-shot injury. The shots were fired in the context of a domestic quarrel, an attempted homicide and a domestic misfortune. Two patients suffered late post-traumatic seizures (more than eight days after trauma), one patient developed early post-traumatic seizures (within seven days). In two of the three patients metal fragments were retained intracerebrally. All three patients became seizure-free with prolonged antiepileptic drug treatment. In contrast to military series, traumatic brain injury caused by penetrating gun-shot injury seems to have a much better prognosis in the civilian population.

Literatur

  • 1 Hauser W A. Incidence and prevalence. In: Engel J Jr, Pedley TA (eds) Epilepsy. A comprehensive textbook. Philadelphia; Lippincott-Raven 1997: 47-57
  • 2 Caveness W F, Meirowsky A M, Rish B L. et al . The nature of posttraumatic epilepsy.  J Neurosurg. 1979;  50 545-553
  • 3 Salazar A M, Jabbari B, Vance S C. et al . Epilepsy after penetrating head injury, I: clinical correlates: a report of the Vietnam Head Injury Study.  Neurology. 1985;  35 1406-1414
  • 4 Annegers J F, Grabow J D, Beghai E. et al . Seizures after head trauma: a population study.  Neurology. 1980;  30 683-689
  • 5 Hesdorffer D C, Verity C M. Risk factors. In: Engel J Jr, Pedley TA (eds) Epilepsy. A comprehensive textbook. Philadelphia; Lippincott-Raven 1997: 59-67
  • 6 Garga N, Lowenstein D H. Posttraumatic epilepsy: A major problem in desperate need of major advances.  Epilepsy Curr. 2006;  6 1-5
  • 7 Lillard P L. Five years experience with penetrating craniocerebral gunshot wounds.  Surg Neurol. 1978;  9 79-83
  • 8 Sherman W D, Apuzzo M LJ, Heiden J S. et al . Gunshot wounds to the brain - A civilian experience.  West J Med. 1980;  132 99-105
  • 9 Caveness W F, Walker A E, Ascroft P B. Incidence of posttraumatic epilepsy in Korean veterans as compared with those from World War I and World II.  J Neurosurg. 1962;  19 122-129
  • 10 Caveness W F. Epilepsy, a product of trauma in our time.  Epilepsia. 1976;  17 207-226
  • 11 Aarabi B, Taghipour M, Haghnegahdar A. et al . Prognostic factors in the occurrence of posttraumatic epilepsy after penetrating head injury suffered during military service.  Neurosurg Focus. 2000;  8 e1
  • 12 Tudor M, Tudor L, Tudor K I. Complications of missile craniocerebral injuries during the croatian homeland war.  Military Medicine. 2005;  170 422-426
  • 13 D'Ambrosio R, Perucca E. Epilepsy after head injury.  Curr Opin Neurol. 2004;  17 731-735
  • 14 Beghi E. Overview of studies to prevent posttraumatic epilepsy.  Epilepsia. 2003;  44 (Suppl 10) 21-26
  • 15 Temkin N R, Dikmen S S, Wilkensy A J. et al . A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures.  N Engl J Med. 1990;  323 497-502
  • 16 Young B, Rapp R P, Norton J A. et al . Failure of prophylactically administered phenytoin to prevent late posttraumatic seizures.  J Neurosurg. 1983;  58 236-241
  • 17 Vespa P R, Nuwer M R, Nenov V. et al . Increased incidence and impact of nonconculsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring.  J Neurosurg. 1999;  91 750-760
  • 18 Askenasy J JM. Association of intracerebral bone fragments and epilepsy in missile head injuries.  Acta Neurol Scand. 1989;  79 47-52
  • 19 Angeleri F, Majkowski J, Cacchio G. et al . Posttraumatic epilepsy risk factors: one-year prospective study after head injury.  Epilepsia. 1999;  40 1222-1230
  • 20 Frey L C. Epidemiology of posttraumatic epilepsy: a critical review.  Epilepsia. 2003;  44 (suppl 19) 11-17

Dr. Monika Bös

Neurochirurgische Klinik, Universitätsklinikum Bonn

Sigmund-Freud-Str. 25

53105 Bonn

Email: m.boes@uni-bonn.de

    >