Diagnostic Subdural EEG-electrode And Subdural hEmatoma (DISEASE)
Diagnostic Subdural EEG-electrode And Subdural hEmatoma (DISEASE)
Epileptic seizures are one of the frequent complications in patients with traumatic brain
 injury; the incidence lies approximately at 20%. Particularly, acute subdural hematoma (aSDH)
 is one of the most important predictors for epileptic seizures, which is besides other
 parameters like age, preoperative Glasgow coma scale, cerebral herniation, hematoma volume
 and time to operation, associated with worse neurological outcome. In a recent systematic
 review, the mean incidence of epileptic seizures in aSDH was 28%, whereas one retrospective
 study focusing on EEG-diagnostic reported very high incidence of epileptiform abnormalities
 on surface EEG in 87% of patients with aSDH, wherefore the question rises, if the incidence
 of epileptic seizures is underestimated.

 Despite successful evacuation of subdural hematoma, approximately one third of patients show
 no clinical improvement without medical explanation. Routinely, surface spot EEG is performed
 to detect epileptic seizures; however the sensitivity is limited due to the skin-bone barrier
 and the short duration of recording. Furthermore, surface EEG is not always available, for
 example during the night or at weekends, which is an additional limitation for the loss of
 treatment timing as well. Spot surface EEG will record for only 20 to 30 minutes in contrast
 to continuous EEG recordings that are performed for hours or days.

 Due to the clinical relevance of epileptic seizures, several studies investigated the benefit
 of prophylactic antiepileptic treatment. To date, there is only one recommendation from the
 Brain Trauma Foundation at evidence class II to treat patients with severe traumatic brain
 injury with prophylactic antiepileptic treatment during the first week. Beyond the interval;
 there was no clinical benefit for patients selected. Still, there are some
 limitations´wherefore the clinical use of prophylactic antiepileptic treatment varies between
 clinicians and countries. At that time, the standard medication was phenytoin which has
 several side effects, but to date, there are several new intravenous antiepileptic drugs with
 comparable effect but better safety profile. On the other hand, there was no sifferentiation
 made between high-risked seizure prone patients, like patients with aSDH, and low-risked
 patients which is one of the limiting factors to support a general recommendation. Therefore
 the role of prophylactic antiepileptic treatment is still questionable.

 In the clinical routine, invasive EEG-electrodes are commonly used to detect epileptic focus.
 The benefit of those electrodes is the real time analysis in case of seizure occurrence
 compared to surface EEG. Moreover, therapeutic effect is directly visible through the
 monitoring. Therefore the idea of this study was to make a real time analysis possible for
 patient with TBI, particularly aSDH, to have diagnostic and therapeutic real time monitoring
 detecting subclinical seizures.
Inclusion Criteria:

 -  Adult patients (aged ≥18 years)

 -  Symptomatic aSDH needing operative treatment via craniotomy or craniectomy

 -  Informed consent

 Exclusion Criteria:

 -  Patients with infaust prognosis

 -  Asymptomatic patients with conservative treatment

 -  aSDH as a secondary diagnosis

 -  Concurrent enrollment in any other trial