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Post-Traumatic Epilepsy

Learn about the scope of post-traumatic epilepsy with statistics and risk factors. Discover symptoms, evaluation, and treatment options for patients with TBI and seizures. Find out about preventive measures and the latest research on epilepsy after trauma.

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Post-Traumatic Epilepsy

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  1. Post-Traumatic Epilepsy Enrique Feoli MD North East Regional Epilepsy Group 2014

  2. Videos • https://www.youtube.com/watch?v=BfQ8OxErihk • https://www.youtube.com/watch?v=eW9GRDe4v-Y • http://www.youtube.com/watch?v=nZ8p90Bfqng&feature=player_detailpage

  3. Scope of the issue: USA • 1.7 million/Year* (adult and children) • *leading cause of death and disability USA and other industrialized countries • 3.2-5.3 mill. citizens /w lifelong disability • 53K Die from TBI (Ann Average) • Firearms 35% 15-34y/o + > 75 y/o(8.5 and 10.5/100K) • MVA 31% 15-24 y/o • Falls 16.7 >75 y/o • Estimate annual cost of TBI ($60 billion US) • http://www.cdc.gov/nchs/data

  4. Terminology • Early seizures (1 to 7 days) Immediate Sz Late seizures (epilepsy) ( 0 to 24 hs) (40% in the firs 6 months) Trauma 7 days

  5. TBI: Civilian Background • Motor vehicles/Falls (75%) • Men “excel”: TBI: 2-2 ½ times vs. women • Bimodal • Young • Old men

  6. Criteria for TBI • Loss of Awareness (consciousness) • Sustained focal deficit • Imaging abnormality (ICH, Contusion…)

  7. Key Point: Severity of TBI • Mild: GCS: 13-15 • Moderate: GCS: 9-12 • Severe: GCS: 8 or less; obtunded/coma

  8. TBI and Seizures

  9. Risk of Post Traumatic Epilepsy • Mild: 1.5% • Moderate: 4.0% • Severe: 28%

  10. Risk Factors for PTE • Severity of Head Injury! • > 65 years of age • Brain contusion • Intra-cerebral hematoma • Early Seizures (1st week post trauma)

  11. Seizure Risk in Brain Injuries Evaluation of Seizure Risk

  12. PTE-How Long to Develop? • Highest: first year. • Decreases each year • Mild TBI : Standardized incidence ratio: 1.5 in the first 5 years • Mod TBI: SIR: 2.9, inc. Risk lasted 10yrs. • Severe TBI: SIR:17, inc risk lasting 20 yrs

  13. TBI Symptoms Epilepsy Seizures, Complex Partial Simple partial seizures Secondary generalized Psychogenic Non Epileptic events, about 30 % of patient with TBI have PNES

  14. TBI Symptoms • posttraumatic stress disorder • anxiety disorders, • personality disorders, • aggressive disorders, • cognitive changes, • chronic pain, • sleep problems, • motor or sensory impairments, endocrine dysfunction, gastrointestinal disturbances, • parkinsonism, 

  15. Humeral Fracture after generalized status epilepticus

  16. Aspiration Pneumonia after GTC Seizure

  17. Burns

  18. PTE Treatment • Severe TBI Acute Prophylaxis: • Typically 7 Days (phenytoin) • Does not modify course/prevent late seizures • Acute and Chronic: once established • Medications (greater than 22 available) • Modify lifestyle • Machines • Surgery

  19. Can PTE be Prevented • Early seizures (1 to 7 days) Immediate Sz Late seizures (epilepsy) ( 0 to 24 hs) (40% in the firs 6 months) Trauma 7 days

  20. Mechanism of injury in TBI Defining TBI and Seizure

  21. “Shear” Injury

  22. GSW

  23. Doc: “I got a headache”….

  24. Long Term: Encephalomalacia

  25. Brain Trauma

  26. Prevention Trials • Anti seizure medications • Hypothermia • Magnesium

  27. Early seizures (1 to 7 days) Immediate Sz Late Dilantin Carbamazepine Phenobarbital Levetiracetam Have all been proven to be effective in decreasing the frequency of early pot-traumatic seizures, however none have shown the decrease the incidence of PTE Can PTE be Prevented Trauma 7 days

  28. Animals Effect of treatment on the epileptogenesis after TBI in experimental models • Rimonabant sinngle dose6 wk Echegoyen et • Minozac 6 h post-TBI two doses7 d Chrzaszcz et al. 48 • Ketogenic diet Schwartzkroin et • HypothermiaParasagittal FP30 min post-TBI for 4 h12 wk Atkins et al.

  29. Hypothermia • No studies in human

  30. Magnesium • No studies in humans

  31. Conclusions

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