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BMJ 2009; 338 doi: (Published 03 March 2009) Cite this as: BMJ 2009;338:b863

Risk of epilepsy lasts for years after head trauma

People with head injuries have an increased risk of epilepsy that peaks in the first two years after the event but remains significantly higher than normal for up to 10 years, say researchers. In a study of more than 1.6 million Danish children and young adults, the overall relative risk of epilepsy after a mild injury was 2.22 (95% CI 2.07 to 2.38), and after a more severe injury it was 7.4 (6.16 to 8.89). The relative risks were lower but still significant (1.51 and 4.29) after 10 years. Skull fracture was also associated with an enduring risk of later epilepsy (overall risk 2.17, 1.73 to 2.71).

The researchers studied all Danish residents born between 1977 and 2002 and followed them up for the same period in the Danish hospital register. In this in the cohort of 1 605 216 people, 78 572 had a traumatic brain injury and 17 470 developed epilepsy. The link was strongest for people over 15 at the time of injury and for people with a family history of epilepsy.

Data from hospital registers are never perfect, says a linked editorial (doi:10.1016/S0140-6736(09)60215-4). But this study is more robust than most and shows that the risk of epilepsy lasts longer than we thought. The pathogenic process is a long one, which at least gives us plenty of time to subvert it.

Cardiovascular guidelines fail their target audience

An analysis of guidelines produced jointly by the American College of Cardiology and the American Heart Association shows that although cardiovascular guidelines are getting longer and more complex, a continuing shortage of good evidence means the recommendations are even less secure now than they were in the 1980s. The researchers report an overall shift towards class II recommendations—those with caveats warning readers of uncertainty in the evidence.

Expert opinion, case studies, and standard practices are still …

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