The high numbers of soldiers who have suffered traumatic brain injuries associated with the wars in Iraq and Afghanistan face an array of health challenges, including post-traumatic stress disorder (PTSD) and other mental health issues.
Now new research published in Neurology®, the medical journal of the American Academy of Neurology, highlights another finding: these soldiers are at a significantly high risk of developing epilepsy even decades after the brain injury occurred.
It’s unclear how head injuries cause epilepsy, however, especially so many years later. In some individuals, the seizures can be very subtle and difficult to identify. People may have memory problems, unexplained changes in behavior, emotional outbursts, or times when they stare into space.
Because each of these symptoms can also be caused by other problems associated with post-traumatic brain injury, the presence of epilepsy is not always identified.
For the study, researchers asked 199 veterans who experienced a brain injury 35 years prior whether they ever had a seizure. They were also given intelligence tests. The group underwent scans to detect brain lesions.
Of the 199 people, about 44 percent developed post-traumatic epilepsy.
“For a surprising 13 percent, the post-traumatic epilepsy didn’t show up until more than 14 years after the brain injury,” said study author Jordan Grafman, PhD, of the National Institute of Neurological Disorders and Stroke in Bethesda, Md.
Cognitive decline later in life was also seen among some of the veterans with seizure disorders. This was assessed by comparing past scores on the Armed Forces Qualification Test (which is given to potential soldiers to measure mental ability) to more recent ones.
“You can have an injury and get better, but with time, people don’t always do as well as they should,” said Dr. Gerald Grant, associate professor of neurosurgery at Duke University in Durham, N.C., and a former Air Force neurosurgeon.
The study also found that some vets who had developed post-traumatic epilepsy experienced worsening of seizures over the years.
In the most recent year that the study participants reported their seizures, a quarter had simple partial seizures during which people stay alert and can recall what happened that had progressed into generalized seizures, which can trigger a loss of consciousness.
The seizures occurred despite the fact that more than 88% of those with post-traumatic epilepsy were on anti-epilepsy drugs.
“Given the better chances of survival in soldiers fighting in conflicts today, our research suggests that all veterans with a traumatic brain injury should be routinely screened for post-traumatic epilepsy, even decades after the injury,” said Dr. Grafman.
“This research strongly suggests that veterans with brain injury will require long-term neurology care.”
The one bright light on the horizon is that major new research is beginning into ways to predict exactly who is most at risk and how to protect their vulnerable brains. Among the efforts are pilot studies to see if the newer seizure-treating drugs Topamax or Keppra might actually prevent epilepsy if they’re taken immediately after a serious brain injury.
Phylis Feiner Johnson www.epilepsytalk.com