Understanding Post-traumatic Epilepsy

Brain damage or brain injury occurs when the brain cells known as neurons are destroyed. This can be caused by internal or external mechanisms. When the damage is related to an external physical trauma, the term traumatic brain injury (TBI) is used. Motor vehicle accidents, firearms, falls, sports, and physical violence are the leading causes of TBI with significant disability and mortality rates.

Paralysis, hydrocephalus (excessive accumulation of fluid in the brain), poor coordination, behavioral changes, and seizures are examples of neurological complications or sequelae (negative aftereffects) associated with TBI.

Generally, seizures after TBI can appear early (within one week of the injury) or later. Early seizures should be treated promptly, because they can produce further damage to the already-injured brain. Later seizures, those that begin at least one week after the injury, tend to become recurrent and therefore qualify as “epilepsy.” During seizures there is an abnormal electrical discharge in the brain. Symptoms can include staring and unresponsiveness, stiffening or shaking of the body, legs, arms or head; strange sound, taste, visual images, feeling or smell; inability to speak or understand, etc.

TBI is the most significant cause of symptomatic epilepsy in people from 15 to 24 years of age. Post-traumatic epilepsy (PTE) is by definition from a focal (localized) injury, and the frontal and temporal lobes are the most frequently affected regions. The likelihood of developing (post-traumatic) epilepsy after a TBI is higher with greater severity of the trauma, for example penetrating head injuries, when there is intracranial hematomas (bleeding), depressed skull fractures, a coma lasting more than 24 hours, and early seizures. As is true for non-traumatic epilepsy, imaging (MRI) often fails to show the cause, and, in that situation, it can be difficult to establish that epilepsy is post-traumatic.

Preventing head trauma is the key to the prevention of the posttraumatic epilepsy. The preventive use of anti-epileptic drugs can decrease the risk of early post-traumatic seizures, but may not prevent late seizures.

About 80% patients with PTE start having seizures within the first two years after the injury. Eventually the risk decreases after five years, and about half of the patients with late PTE have remission spontaneously.

Generally patients with PTE only require hospital admissions when EEG video monitoring is necessary because treatment is not working or for treating status epilepticus (seizures that last longer than five minutes).

Finally, as is true for all patients with seizures (post-traumatic or not), if basic treatment (medications) do not work, the next step is an evaluation at a specialized epilepsy center. This would begin with EEG-video monitoring to confirm and clarify the diagnosis, localize the seizures, and allow the patient and medical team to examine all treatment options.