Blog #48: Post-Concussion Epilepsy Can Be Hard to Recognize

(This blog was originally posted on July 24, 2014)

 

Concussions are caused by a non-penetrating trauma to the head such as blows to the head and exposure to nearby explosions as in war. Symptoms of mild concussion include dizziness, blurry vision, vomiting, ear-ringing and tiredness. These may last a few minutes or continue for weeks or longer. More severe concussion results in loss of consciousness that can be followed by headaches, confusion (thinking as if in a fog), memory loss and depression. When neurons (brain cells) are injured during a serious concussion, epilepsy can develop.

          Epilepsy is defined as more than one seizure, even when they are separated by 5-10 years or more. They can be very subtle. These post-concussive seizures may not cause convulsive falling, jerking, tongue biting or incontinence that people commonly associate with epilepsy.

These subtle types of seizures are especially hard to recognize. The person may “blank out” or suddenly lose concentration for a few seconds days, months or even years after the original head trauma. Family and observers often dismiss this behavior or don’t even notice the sudden confusion, blank facial expression and cessation of speech, let alone think it might be a seizure.

Professional medical staff often misdiagnosis post-traumatic stress disorder (PTSD) when it actually is post-traumatic epilepsy. Very brief loss of contact with the person’s environment is the diagnostic clue. Loss of contact with surroundings by “blinking out” or short confusion and cessation of speech may be all that happens.

When psychiatrists evaluate people whose personalities seem changed the above symptoms may be the only clues that non-convulsive epilepsy, and not a psychiatric disorder, is the true problem. Since brain scans and EEGs can be normal in people with epilepsy neurologists are the most expert at sorting out the symptoms and giving the proper treatment.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel. It is a mother’s dramatic story that teaches epilepsy.