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Post Traumatic Epilepsy: Next Wave of Brain Injury For Returning Soldiers

Traumatic brain injury has become known as the signature injury of the current conflicts in Iraq and Afghanistan, yet it may represent just the tip of the iceberg when it comes to the long-term neurological and financial costs of the wars. Speakers at the Presidential Symposium of the annual ANA meeting said that one injury that still hasn't been fully appreciated is post traumatic epilepsy.

“Over 4,000 US soldiers have died, and many, many more have been injured,” said American Neurological Association (ANA) President Tim Pedley, Chairman of Neurology at Columbia, in introducing the speakers. “The changed nature of warfare in Iraq has led to a higher number of brain injuries and persistent disabilities, including epilepsy and neuropsychiatric disorders.” Pedley said he selected the topic for this year’s symposium - Neurological Injuries Caused by War: What Have We Learned from Iraq and Afghanistan? - to examine not only the type of injury and subsequent disability, but also why head injuries are more common and what the long-term financial impact might be on society.

The future wave of post-traumatic epilepsyy among survivors of war induced TBI represents another challenge that the United States and Iraq may be ill-equipped to deal with, according to a review of data presented by Dan Lowenstein, UCSF vice chair of neurology and director of the UCSF epilepsy center. Studies from four previous wars, from World War I to Vietnam, show a “remarkably consistent pattern,” he said, with five-year incidence ranging from 22 percent to 43 percent (median: 34 percent) among combatants. As many as half develop epilepsy within a year of the injury, studies suggest, but in a significant number, epileptic seizures first appear several years later, even a decade or more in some cases. The four studies that examined epilepsy rates 10 or more years after head injury, representing a total of more than 3,000 participants, found that approximately 45 percent of those with penetrating wounds had developed epilepsy at 10 years post-injury.

Given the sometimes-delayed onset of symptoms, combined with the lack of solid data on the prevalence of moderate and severe TBI in combatants and civilians (who have also been exposed to blasts associated with traumatic brain injury), the number of people in the current wars who may eventually develop epilepsy is “essentially unknown.”

“Post-traumatic epilepsy is a common and predictable cause of epilepsy, with a 35 to 45 percent incidence among combatants, and no anti-epilepsy therapy exists that has been shown to prevent the development of epilepsy following TBI,” Lowenstein concluded. “This is an area ripe for clinical translation.”

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Comments

Joseph W. Shadowens SSG US ARMY

Sir I found this article interesting from personal experience as I am a soldier that suffers with seizures from several TBI's and Cervical spinal injuries. I have found that a large percentage of these cases in the Military are being treated as psychological in nature as Post Traumatic Stress Disorder (PTSD) is often associated with these common injuries. Specifically PNES, (Psychogenic Non-Epileptic Seizures) with a simplified diagnosis of Conversions disorder. Is it possible to develop non-epileptic seizures as a result from TBI and what is the treatment If not psychological in nature and all of the standard Epilepsy medications have in fact increased the frequency and intensity of said events. Frankly, "Pseudo Seizures" or "Conversions disorder" is a hard diagnosis to swallow when you consider the mental instability a person must undergo to consider chewing their own tung off.

Stacey Edwards

I am very interested in this article and was curious if you have encountered "psuedo-seizures" or non-epileptic seizures as a side effect of TBI, specifically in the veteran population. In addition, I was curious if these "psuedo seizures" could cause, on their own, a personality change similar to frontal lobe injury changes?

Thanks

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