Traumatic brain injuries and epilepsy — what you need to know

Traumatic brain injuries and epilepsy — what you need to know | January 15, 2023

In a fraction of a second, head trauma can dramatically change a person’s life.

Head trauma caused by falls, physical abuse, violence, vehicle crashes and sporting accidents, not to mention modern warfare.

However, it’s important to realize that not all head injuries, even severe ones, result in seizures. And seizures frequently occur in people who haven’t experienced head trauma.

But close associations do exist between head trauma and seizures — as much as twelve times as opposed to someone without a head trauma.

The difficulty of a diagnosis is that epilepsy does not typically develop immediately after head trauma.

Studies suggest that approximately 6% of patients with epilepsy have TBI as the cause. It generally depends upon how severe the head trauma is.

Immediate or Mild Seizures:
They may develop immediately after the accident. The person is awake with eyes open. Symptoms can include confusion, disorientation, memory loss, headache, and a brief loss of consciousness.

Early Onset or Moderate Seizures:
Will usually develop with the first 24 hour hours. Loss of consciousness lasting 20 minutes to 6 hours may occur, as well as some brain swelling or bleeding causing sleepiness, but still arousable.

Late or Severe Seizures:
Is when the person is unconscious. Their eyes don’t open, even with stimulation. Loss of consciousness lasts more than 6 hours.

But a seizure disorder can develop days, weeks, a month or even years following a brain trauma!

The risk of future seizures and traumatic epilepsy is increased by each successive seizure.

And the more severe the head trauma, the higher the risk of having seizures.

While many types of seizures may be caused by a traumatic incident, the most common are partial (focal) seizures or tonic-clonic (formerly known as grand mal) seizures.

An early seizure may not require treatment, but a seizure or two occurring later would be treated by many doctors with the usual anti-seizure medications, such as:

Tegretol (Carbamazepine), Lamictal (Lamotrigine), Keppra (Levitiracetam), Neurontin (Gabapentin, Trileptal (Oxcarbazepine), Phenobarbital, Dilantin (Phenytoin), Lyrica (Pregabalain), Topamax (Topiramate), Depakene or Depakote (Valproic Acid or Valproate) and Zonegran also known as Zonisamide.

Head trauma can also cause many problems in addition to seizures: migraine headaches, memory and concentration problems, dizziness, mood swings and various other symptoms known as the concussion syndrome.

Even after seemingly minor trauma, these symptoms can persist for months. With more severe head trauma, neurological symptoms can sometimes be permanent.

According to the CDC — Centers for Disease Control and Prevention:

About one-third of injury related American deaths are linked to TBI…
About 230,000 hospitalizations occur annually in the USA as a result of TBI…
1.1 million Americans are treated for TBI…
Almost 2% of the US population lives with TBI-related disabilities…
About 2 million American adults and children suffer from TBI annually…
50,000 patients die annually in America as a result of TBI…
Every 15 seconds one American man, woman or child sustains a traumatic brain injury…
11% of TBIs are caused by firearms — the leading cause of deaths related to TBI.

But there is hope for the future, regardless of whether your epilepsy is the result of Traumatic Brain Injury or not.

Promising New Research
Surgeons at Washington University School of Medicine in St. Louis are testing the ability of a cooling grid to reduce seizures that cannot be controlled through medication or surgery.

“Traumatic head injury is the leading cause of acquired epilepsy in young adults, and in many cases the seizures can’t be controlled with medication,” says Matthew Smyth, MD, associate professor of neurological surgery and of pediatrics at Washington University School of Medicine in St. Louis.

“If we can confirm cooling’s effectiveness in human trials, this approach may give us a safe and relatively simple way to prevent epilepsy in these patients.”

Cooling the brain to protect it from injury is not a new concept.

Cooling slows down the metabolic activity of nerve cells, and scientists think this may make it easier for brain cells to survive the stresses of an injury.

Doctors currently cool infants whose brains may have had inadequate access to blood or oxygen during birth.

They also cool some heart attack patients to reduce peripheral brain damage when the heart stops beating.

Smyth and his collaborators have been exploring the possibility of using cooling to prevent seizures or reduce their severity.

“Warmer brain cells seem to be more electrically active, and that may increase the likelihood of abnormal electrical discharges that can coalesce to form a seizure,” Smyth says. “Cooling should have the opposite effect.”

The study is the first to reduce injury-related seizures without drugs, according to Smyth, who is director of the Pediatric Epilepsy Surgery program at St. Louis Children’s Hospital.

“Our results show that the brain changes that cause this type of epilepsy happen in the days and weeks after injury, not at the moment of injury or when the symptoms of epilepsy begin,” says Smyth.

“If clinical trials confirm that cooling has similar effects in humans, it could change the way we treat patients with head injuries, and for the first time reduce the chance of developing epilepsy after brain injury.”

Epilepsy Talk