Post Traumatic Epilepsy

What Is It?

Post traumatic epilepsy refers to seizures which occur as the result of a traumatic injury to the brain. Any injury to the brain can cause seizures, including both blunt injury and penetrating injury, such as a gunshot wound. While seizures are generally more common after head injury if there is some form of intracranial hemorrhage (bleeding in or around the brain), such as cerebral contusion, intraparenchymal hemorrhage, subdural hematoma or epidural hematoma, most any form of brain injury can cause seizures.

Frequently, seizures occur acutely following the injury. Only occasionally do the seizures continue into a long term epilepsy condition.

What Types of Symptoms Are Typical?

Following a traumatic injury, traumatic epilepsy can present with a seizure or multiple seizures in an individual who did not previously have epilepsy. Most commonly, these seizures are generalized tonic-clonic (grand mal) seizures but various types of seizures are possible.

In some patients who are in some level of traumatic coma following injury, there may be subclinical or non-convulsive seizures. In other words, the brain may demonstrate seizure activity on electroencephalogram but the patient may not display any outward signs of the seizures due to their coma state.

Only a small subset of patients who experience head injury will go on to have a long-lasting post-traumatic epilepsy.

How Is The Diagnosis Typically Made?

Acute seizures following a trauma are generally easily diagnosed based on the convulsive activity. However, in the case where a patient is comatose or there is any other reason to suspect sub-clinical seizures, an electroencephalogram can be performed to demonstrate brain seizure activity. In some neurological intensive care units, patients are monitored on continuous EEG monitoring to screen for seizure activity.

In the long-term follow-up of patients after head trauma, assessment of ongoing epilepsy may be based both on clinical manifestations and seizure events as well as electroencephalogram.

What Are Some Common Treatments?

Most patients who present with traumatic brain injury, whether they present with an acute seizure or not, will be placed an anti-seizure medication at least temporarily as prophylaxis to prevent seizures. In the case of patients who had no acute seizures, this medication is generally tapered off after the acute post-injury period. In patients who experience seizures after injury, these medications may be continued long-term. If no further seizures occur, withdrawal of the medication may be considered by the treating physicians at a later date, particularly if EEG has not shown any evidence for ongoing abnormal electrical activity in the brain.

A small subset of patients who have ongoing epilepsy after injury may require long-term treatment with anti-epileptics to control seizures.

Patients who experience seizures acutely after trauma in the hospital will often be treated during the seizure with one or more medications to halt the seizure.

The use of anti-seizure medications and the treatment of post traumatic epilepsy should be determined by each patient's own team of treating physicians.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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