Blog #152: Post-Traumatic Head Injury and Epilepsy

On its website, the Epilepsy Foundation recently published an excellent review of Post-Traumatic Head Injury and Epilepsy by Elaine Kiriakopoulos MD, MSc.¹

 

Dr. Kiriakopoulos explains what Traumatic Brain Injury (TBI) is: that it results from significant brain trauma, often accompanied by skull fracture, due to collisions and to shaking infants severely. Here, the infant brain is traumatized by thrusts against structures within the skull. Bruising of the brain occurs in significant concussion. Brain bleeding, however, is more serious. Brain scan imaging can usually demonstrate these different injuries. When trauma is severe brain swelling, (edema) often occurs. Such swelling can cause changes in consciousness as coma, confusion, long term headaches, seizures, motor and sensory abnormalities, and chronic cognitive and personality changes.

Mild head injury may just require reassurance and observation at home. If seizures develop within days these may be temporary and don’t necessarily represent epilepsy, i.e., recurrent seizures. If seizures develop weeks, months, or a few years later, this would fit the condition, “post traumatic” epilepsy.

Dr. Kiriakopoulos’ review relates that early post-traumatic seizures in the first week can be seen in10% of such patients and would not necessarily develop into chronic epilepsy nor require anticonvulsant medications. Prophylactically taking anticonvulsive medications after head trauma as a seizure-deterrent is problematical. Seizures developing later than 1 week is likely post traumatic epilepsy and the seizures will recur in 2% of patients. Seizures developing in year 1 are seen in 50% of post traumatic patients. Such post traumatic seizures occurring during year 2 are seen in 30% and after 2 years in 20%. Some patients develop epilepsy 15 years after the head trauma.

Treatment of this condition includes anticonvulsant medications. The more serious the brain injury the more likely the medication will be less effective. In this situation surgical removal of a significant post-traumatic scar shown to be the focus of the epilepsy (scans, EEGs, etc.) and which is also amenable to safe removal of the abnormal brain tissue without causing significant neurological effects can prove curative. I review surgical treatments of epilepsy on my blogs: Blog #114: EPILEPSY SURGERY IN CHILDHOOD AND LONG-TERM EMPLOYMENT IS ENCOURAGING Blog #121: IF YOUR SEIZURES AREN’T CONTROLLED EPILEPSY SURGERY IS SAFE AND REALLY CAN HELP; and Blog #121: IF YOUR SEIZURES AREN’T CONTROLLED EPILEPSY SURGERY IS SAFE AND REALLY CAN HELP.

  1)     Elaine Kiriakopoulos MD, MSc Assistant Professor of Neurology at the Geisel School of Medicine at Dartmouth College. She is Director, HOBSCOTCH Institute for Cognitive Health& Well-Being Dartmouth-Hitchcock Epilepsy Center.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.