Traumatic brain injury, stroke, and epilepsy; A mediation study in a Danish nationwide cohort by Kasper Lolk, Theis Lange, Felix Elwert, Julie W. Dreier, and Jakob Christensen (2022)

Epilepsia, Accepted Articles

Abstract: (Objective) Traumatic brain injury (TBI) and stroke are well-known causes of acquired epilepsy. TBI is also a risk factor for stroke, and injury-induced stroke may indirectly convey a proportion of the epilepsy risk following TBI. We studied the extent to which the effect of TBI on epilepsy operated through intermediary stroke. (Methods) We analyzed a nationwide, matched, register-based cohort of adults > 40 years of age whose first TBI at Danish hospitals was recorded between 2004 and 2016. A matched reference population was sampled for comparison. During follow-up, we recorded all acute strokes. Cox proportional hazard models and the difference method was used to estimate the total and controlled direct effect hazard ratios (HR) of TBI on epilepsy, the indirect effect HR of TBI on epilepsy operating through stroke, and calculate the proportion eliminated. Analyses were stratified by severity of, age at, and time since TBI.