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A recent study published in Neurology®, the American Academy of Neurology's medical journal, highlights that military veterans who develop epilepsy following a traumatic brain injury (TBI) tend to have a higher mortality rate in the years after diagnosis compared to veterans who develop epilepsy without a prior TBI. This research emphasizes the importance of close monitoring and timely treatment adjustments for those with post-TBI epilepsy, especially when seizures aren’t well controlled, including considering surgery or changing medications promptly.
The study analyzed data from the Veterans Health Administration involving 210,182 veterans diagnosed with epilepsy. Among them, 28,832 had experienced a traumatic brain injury within five years before their epilepsy diagnosis, with an average age of 53 at diagnosis. The rest, 181,350 veterans, had no such injury within five years before their diagnosis and were generally older, averaging 61 years at diagnosis. Participants were followed for an average of six years to monitor mortality outcomes.
During the follow-up period, 10,780 veterans with epilepsy and prior TBI died compared to 92,621 veterans with epilepsy but no recent TBI. After adjusting for study duration and other influencing factors, researchers found that veterans with epilepsy after TBI were overall 2% more likely to die during the study than those with epilepsy without TBI. Mortality risk varied based on the type of brain injury: those with skull or facial fractures had an 18% higher risk, diffuse brain injury had a 17% higher risk, and localized brain injury had a 16% increased risk of death. Interestingly, veterans whose TBI was caused by a concussion showed a lower mortality rate than those with epilepsy but no history of TBI.
Study author Dr. Zulfi Haneef from Baylor College of Medicine suggested possible explanations for these findings. Some epilepsy cases without TBI might result from causes with inherently higher mortality, like stroke, infections, or tumors, skewing comparisons. Also, people developing epilepsy after TBI might receive earlier or more comprehensive care, potentially improving their outcomes relative to those without a TBI history.
The research further found that veterans aged 18 to 39 who developed epilepsy after extracerebral TBI were twice as likely to die during the study compared to young adults with epilepsy but no brain injury. However, a limitation noted was the restricted information on TBIs that occurred before veterans started receiving care from the Veterans Health Administration, potentially affecting the completeness of the data.
Funded by the U.S. Department of Defense, this study underscores the critical need for improved surveillance and treatment strategies for veterans with post-TBI epilepsy to potentially reduce mortality risks. The American Academy of Neurology continues to advocate for brain health by providing trusted information and resources to patients, caregivers, and medical professionals. Neurologists play a crucial role in diagnosing and treating neurological conditions such as epilepsy, traumatic brain injury, and more, further supporting the value of specialized care in these complex cases.
