The high numbers of soldiers who have suffered traumatic brain injuries associated with the wars in Iraq and Afghanistan face an array of health challenges, including post-traumatic stress disorder (PTSD) and other mental health issues.
Now new research published in Neurology®, the medical journal of the American Academy of Neurology, highlights another finding: these soldiers are at a significantly high risk of developing epilepsy even decades after the brain injury occurred.
It’s unclear how head injuries cause epilepsy, however, especially so many years later. In some individuals, the seizures can be very subtle and difficult to identify. People may have memory problems, unexplained changes in behavior, emotional outbursts, or times when they stare into space.
Because each of these symptoms can also be caused by other problems associated with post-traumatic brain injury, the presence of epilepsy is not always identified.
For the study, researchers asked 199 veterans who experienced a brain injury 35 years prior whether they ever had a seizure. They were also given intelligence tests. The group underwent scans to detect brain lesions.
Of the 199 people, about 44 percent developed post-traumatic epilepsy.
“For a surprising 13 percent, the post-traumatic epilepsy didn’t show up until more than 14 years after the brain injury,” said study author Jordan Grafman, PhD, of the National Institute of Neurological Disorders and Stroke in Bethesda, Md.
Cognitive decline later in life was also seen among some of the veterans with seizure disorders. This was assessed by comparing past scores on the Armed Forces Qualification Test (which is given to potential soldiers to measure mental ability) to more recent ones.
“You can have an injury and get better, but with time, people don’t always do as well as they should,” said Dr. Gerald Grant, associate professor of neurosurgery at Duke University in Durham, N.C., and a former Air Force neurosurgeon.
The study also found that some vets who had developed post-traumatic epilepsy experienced worsening of seizures over the years.
In the most recent year that the study participants reported their seizures, a quarter had simple partial seizures during which people stay alert and can recall what happened that had progressed into generalized seizures, which can trigger a loss of consciousness.
The seizures occurred despite the fact that more than 88% of those with post-traumatic epilepsy were on anti-epilepsy drugs.
“Given the better chances of survival in soldiers fighting in conflicts today, our research suggests that all veterans with a traumatic brain injury should be routinely screened for post-traumatic epilepsy, even decades after the injury,” said Dr. Grafman.
“This research strongly suggests that veterans with brain injury will require long-term neurology care.”
The one bright light on the horizon is that major new research is beginning into ways to predict exactly who is most at risk and how to protect their vulnerable brains. Among the efforts are pilot studies to see if the newer seizure-treating drugs Topamax or Keppra might actually prevent epilepsy if they’re taken immediately after a serious brain injury.
Other articles of interest:
Pentagon’s Spending On Key Injuries Isn’t Being Tracked Well, Auditors Say
The report by the Government Accountability Office says that nobody in the Defense Department coordinates all the programs on brain injuries and PTSD. It finds that by law the Defense Department is required to keep track of who has spent what, and on what kinds of treatments and studies. But auditors checking the figures have discovered the numbers are “unreliable.”
The head of a congressional subcommittee announced today that she is looking into why the Pentagon’s health plan won’t pay for veterans with traumatic brain injuries to receive an intensive form of rehabilitation.
Military’s Brain-Testing Program A Debacle
The U.S. military has spent more than $42 million to test every service member’s brain to find out who suffered a traumatic brain injury, or TBI, during the Iraq and Afghanistan wars. But an investigation by NPR and ProPublica has found that military leaders are refusing to carry out the testing program as Congress ordered. Partly as a result, the program that was supposed to fix things has hardly helped any of the troops.
Few Troops Exposed To Bomb Blasts Are Screened For Concussion
More than half of U.S. combat troops in Afghanistan have been exposed to bomb blasts in the last year, but only about 1 in 5 of them said they were examined for concussions, according to a draft of a recent military survey.
‘Critical’ Shortage Of Army Neurologists For Troops
The Army is facing a “critical” shortage of neurologists, partly because of recent policy changes designed to improve diagnosis and treatment of mild traumatic brain injuries, according to a new military medical memorandum.
Scientific Review Kicks Off To Weigh Treatment For Brain-Injured Soldiers
The Institutes of Medicine kicked off its yearlong study of cognitive rehabilitation therapy on Monday, a process that will help the Pentagon decide whether its health plan will cover the treatment for troops who have suffered brain injuries in Iraq and Afghanistan.
TBI Increases Odds For Depression, Behavior Impulsivity, PTSD In Patients With Nonepileptic Seizures
A new study by a Rhode Island Hospital researcher has found that traumatic brain injury (TBI) can significantly increase the odds of having major depression, personality impulsivity and post-traumatic stress disorder (PTSD) in patients with psychogenic nonepileptic seizures (PNES). The paper, by W. Curt LaFrance Jr., M.D., M.P.H., director of neuropsychiatry and behavioral neurology, is published online in advance of print in the journal Epilepsia.
Seizures and Epilepsy: A Significant Burden On Veterans http://www.sciencedaily.com/releases/2013/12/131209104914.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine%2Fepilepsy+%28ScienceDaily%3A+Health+%26+Medicine+News+–+Epilepsy+Research%29
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American Academy of Neurology