Rethinking Seizure Care Blog

A Look at Post-Traumatic Epilepsy Following Severe Head Injury

Posted by RSC Diagnostics on Apr 28, 2021

Young man with trauma of the head

TBI or traumatic brain injury is something that results from a sudden injury to the head that leads to damage in the brain. It can be open or closed, meaning you take a sharp blow to the head, but nothing penetrates the skull OR you do sustain an open head injury in which an object passes through the skull into the brain tissue. As the American Speech Language Hearing Institute explains, regardless of the cause of the TBI, they always cause "two types of damage to the brain: primary brain damage, which is damage that occurs at the time of impact (e.g., skull fracture, bleeding, blood clots), and secondary brain damage, which is damage that evolves over time after the trauma (e.g., increased blood pressure within the skull, seizures, brain swelling)."

The consequences of any TBI vary, and can be quite wide ranging. They can lead to physical problems with balance, muscle movement, paralysis and more. There might also be sensory deficits resulting from the damage, behavioral change, cognitive deficits, communication issues and dysphagia (a problem with swallowing). There is also the risk of seizures.

A TBI May Cause Seizures

The Model Systems Knowledge Translation Center explains that one in ten patients with a TBI will end up having at least one seizure that is the result of the injury. The seizure is due to the sudden and abnormal electrical disturbance within the brain and it can cause such noticeable symptoms as unusual bodily movements, unresponsiveness, experiencing strange odors or sounds, experiences of sudden and extreme fatigue, and an inability to communicate.

Among the patients who do experience seizures after a TBI, there are often three ways the seizures occur:

  • As an early post-trauma event - Usually within a week of the injury a seizure occurs. Roughly one-quarter of TBI victims have this variety and then will have another weeks or months later.
  • As a late post-trauma event - This is one that occurs a week or more after the injury. Of those that do, 80% will also go on to have further seizures.
  • Epilepsy - Those suffering more than a single seizure are often diagnosed as epileptic, and of those who develop it after TBI, around 50% will continue to have it as a permanent condition.

Interestingly, physicians and medical experts now agree that the cause of a TBI injury may offer some insight as to whether the patient is going to develop seizures. For example, a large number of bullet wound sufferers will have seizure activity of some kind. Another 20% of closed wound patients have seizure due to bleeding. When a patient requires two or more post injury surgeries on the brain, it increases their chance of suffering seizures substantially, with 35% of patients in this category developing seizure issues.

Treating Seizures in Post-TBI Patients

If someone who is suffering post-TBI seizures, or develops epilepsy, the medical team will usually assess their medication options. Many receive AEDs or anti-epileptic drugs, and these usually reduce or halt seizure activity within five days of beginning their use. If they fail to get seizures under control, it is not unusual for a physician to add further AEDs to the regimen, with common formulas including carbamazepine, levetiracetam, oxcarbazepine, phenytoin, topiramate, zonisamide, lamotrigine, gabapentin, phenobarbital, pregabalin or valproic acid.

If medication regimens fail to yield results, and seizure activity continues, a comprehensive assessment at a formal epilepsy specialist is the next step. This will include brain wave testing, assessments of seizures and other approaches to getting the seizures under control and even addressing their cause and/or sources.



Topics: PTSD and Seizures