VIRGINIA COMMONWEALTH UNIVERSITY

NATIONAL RESOURCE CENTER
FOR TRAUMATIC BRAIN INJURY

Neuropsychology and Rehabilitation Psychology Division Department of Physical Medicine and Rehabilitation.

Seizures

QUESTION:

My husband had seizures right around the time of the head trauma. He was put on medication which controlled the seizures. How long will he need to take this medication? Is it possible that he eventually can stop the medication and be seizure-free?

ANSWER
Prophylaxis (prevention) of seizures after moderate and severe TBI (mild TBI does not increase seizure incidence and therefore does not require any prophylaxis) involves the use of Dilantin (phenytoin) for a 7-day period after injury. Additional medication has not been shown to be any more efficacious. "Immediate seizures" (within the first 24 hours of injury) are only treated with the 7-day period of Dilantin that one would use for prophylaxis (they do not increase the risk of "early" or "late" seizures). "Early seizures" (24 hours to 1 week after injury) are not always treated similarly; however, in general, they should be treated for 3-6 months with an anticonvulsant (it does not matter which one ... Dilantin, Tegretol, Valproic Acid). Some folks will get a brain wave tracing (EEG) before stopping treatment, but it is not clear what is best. "Late seizures" (after 1 week post-injury) should be treated with similar agents for at least 6 months. If the seizures were "status epilepticus" in nature (continuing for more than 2-5 minutes), then treatment should probably extend to a year. A new head CT is appropriate for new "late" seizures (the first one), and an EEG is appropriate before stopping medications.

QUESTION:
My sister had a severe brain injury due to an assault. I have heard about post-traumatic seizures, and I am worried about her having them. Do all brain injury patients experience post-traumatic seizures? Is this a life-long condition?

ANSWER
Seizures, or "Post-Traumatic Epilepsy," occur in three time frames after traumatic brain injury: Immediate (within the first 24 hours), Early (24 hours to 1 week after injury), and Late (after 1 week post-injury). The incidence of seizures after moderate to severe TBI is approximately 15-20% for the first year (and perhaps 25-30% for 4 years, although this has not been well studied), with most occurring in the "Late" phase. Additionally, of those individuals who develop late seizures, approximately 25% will do so after the first year (and can do so for as long as 4 years post-injury). Things which predispose to early and later seizures are: depressed skull fractures, focal bleeding within the brain tissue with associated swelling, focal neurologic deficits (hemiparesis), and penetrating injuries. Additionally, if you have an "early" seizure you are more likely to have a "late" seizure. An "immediate" seizure does not increase your risk for later seizures. A prior seizure disorder (unrelated to excessive alcohol or drug use and withdrawal) also increases your overall risk for all types of seizures.

Seizures can be manifest in a number of ways. The most common seizure type is labeled a "Complex Partial Seizure," which means involvement (twitching, drawing up) of a part(s) of the body with associated alteration (or loss) in consciousness. It is different from the "Generalized" (Grand Mal) or "Tonic-Clonic Seizure" one typically thinks of, where one has uncontrolled twitching and jerking of the entire body with associated loss of consciousness, incontinence, and a period before and after seizure (pre- and post-ictal phase) of altered consciousness. This "Generalized Seizure" is the second most common type. "Simple Partial Seizures" are the third most common type and are similar to the "Complex Partial Seizure" without any alteration or loss of consciousness. "Abscence Seizures" (Petit Mal) with brief alterations in consciousness are fairly rare after TBI, and can be confused with inattention or hypoarousal.

Patients with seizures are restricted from driving for a period of time (it varies from state to state). Additionally, they should not perform any activity during that time period in which they could injure themselves if they sustained a seizure (power tools, climbing ladders/heights, swimming alone, bathing in a bathtub, etc.) In general, however, seizures do not prevent the individual from leading a full, productive life without functional limitations.

QUESTION:
What is the relationship between epilepsy and brain injury? Can a brain injury cause epilepsy in a formerly seizure-free individual?

ANSWER

Brain injury is one of many causes of epilepsy. Epilepsy is not a disease; it is a symptom of a neurologic disorder that affects the brain. The word "epilepsy" comes from a Greek word meaning "to possess, hold or seize" and medically it describes a short-lived burst of energy in the brain . A seizure can strike anyone as a result of a variety of causes, such as a blow to the head, allergic drug reaction, and infections, for example.

There are many different forms of epilepsy, some involving convulsive episodes, while others more subtly affect a person’s ability to sustain attention or create a brief unexplained restlessness and/or experience of feeling "spaced out." Epilepsy can develop immediately after a brain injury or some months or years later, and large numbers of individuals with brain injury never develop epilepsy. The good news is most epilepsy is controllable with medication, and a person can live a normal life. Federal laws prevent discrimination against persons with epilepsy. You may wish to gather more general information about epilepsy by contacting the Epilepsy Foundation of America at 1-800-EFA-1000. Another resource is your local public library or medical library.

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