Logo for the Journal of Rehab R and D

Volume 46 Number 6, 2009
   Pages 685 — 696

Abstract —  Posttraumatic epilepsy and treatment

James W. Y. Chen, MD, PhD;1-2* Robert L. Ruff, MD, PhD;3-4 Roland Eavey, BA;1-2 Claude G . Wasterlain, MD1-2

1Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA; 2Department of
Neurology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; 3Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; 4Case Western Reserve University School of
Medicine, Cleveland, OH

Abstract — Posttraumatic epilepsy (PTE) is a major long-term complication of traumatic brain injury (TBI). PTE usually develops within 5 years of head injury. The risk for developing PTE varies with TBI type. Both Korean and Vietnam war veterans with penetrating TBI had a 53% risk of developing PTE. The risk of developing PTE is between 10% and 25% in combat-associated closed-head trauma with positive brain imaging and about 5% in moderately severe closed-head injury without imaging finding. We do not know the risk of PTE among Operation Iraqi Freedom/Operation Enduring Freedom veterans with minimal TBI because of blast exposure. Partial seizures may manifest with subtle behavioral alterations that can be mistaken for manifestations of posttraumatic stress disorder and improperly treated. Accidents and medical complications commonly occur during seizures. Sudden unexpected death in epilepsy is most frequent among 20- to 40-year-olds. Seizures increase the likelihood of refractory seizures years after TBI. Seizures are also a social stigma that compromise veterans' reintegration into society. People with uncontrolled epilepsy are not allowed to drive and have difficulty obtaining or maintaining employment. Optimal seizure control is essential to the physical and emotional health of veterans with TBI and to their ability to lead productive lives.

Key words: anticonvulsants, brain imaging, posttraumatic epilepsy, posttraumatic stress disorder, refractory seizures, rehabilitation, seizures, traumatic brain injury, unprovoked seizures, veterans.

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