1. Post-Traumatic Epilepsy
Enrique Feoli MD
North East Regional Epilepsy Group
2014

2. Videos https://www.youtube.com/watch?v=BfQ8OxErihk

3. Scope of the issue: USA 1.7 million/Year* (adult and children)
*leading cause of death and disability USA and other industrialized countries
mill. citizens /w lifelong disability
53K Die from TBI (Ann Average)
Firearms 35% 15-34y/o + > 75 y/o(8.5 and 10.5/100K)
MVA 31% y/o
Falls 16.7 >75 y/o
Estimate annual cost of TBI ($60 billion US)

4. Terminology Early seizures (1 to 7 days)
Immediate Sz Late seizures (epilepsy)
( 0 to 24 hs) (40% in the firs 6 months)
Trauma
7 days

5. TBI: Civilian Background
Motor vehicles/Falls (75%)
Men “excel”: TBI: 2-2 ½ times vs. women
Bimodal
Young
Old men

6. Criteria for TBI Loss of Awareness (consciousness)
Sustained focal deficit
Imaging abnormality (ICH, Contusion…)

7. Key Point: Severity of TBI
Mild: GCS: 13-15
Moderate: GCS: 9-12
Severe: GCS: 8 or less; obtunded/coma

8. TBI and Seizures
(6)

9. Risk of Post Traumatic Epilepsy
Mild: 1.5%
Moderate: 4.0%
Severe: 28%

10. Risk Factors for PTE Severity of Head Injury! > 65 years of age
Brain contusion
Intra-cerebral hematoma
Early Seizures (1st week post trauma)

11. Seizure Risk in Brain Injuries
(6)
Evaluation of Seizure Risk

12. PTE-How Long to Develop?
Highest: first year.
Decreases each year
Mild TBI : Standardized incidence ratio: 1.5 in the first 5 years
Mod TBI: SIR: 2.9, inc. Risk lasted 10yrs.
Severe TBI: SIR:17, inc risk lasting 20 yrs

13. TBI Symptoms Epilepsy Seizures, Complex Partial
Simple partial seizures
Secondary generalized
Psychogenic Non Epileptic events, about 30 % of patient with TBI have PNES

14. TBI Symptoms posttraumatic stress disorder anxiety disorders,
personality disorders,
aggressive disorders,
cognitive changes,
chronic pain,
sleep problems,
motor or sensory impairments, endocrine dysfunction, gastrointestinal disturbances,
parkinsonism, 

15. Humeral Fracture after generalized status epilepticus

16. Aspiration Pneumonia after GTC Seizure

17. Burns

18. PTE Treatment Severe TBI Acute Prophylaxis:
Typically 7 Days (phenytoin)
Does not modify course/prevent late seizures
Acute and Chronic: once established
Medications (greater than 22 available)
Modify lifestyle
Machines
Surgery

19. Can PTE be Prevented Early seizures (1 to 7 days)
Immediate Sz Late seizures (epilepsy)
( 0 to 24 hs) (40% in the firs 6 months)
Trauma
7 days

20. Mechanism of injury in TBI
(5)
Defining TBI and Seizure

21. “Shear” Injury

22. GSW

23. Doc: “I got a headache”….

24. Long Term: Encephalomalacia

25. Brain Trauma

26. Prevention Trials
Anti seizure medications
Hypothermia
Magnesium

27. Can PTE be Prevented Dilantin Carbamazepine Phenobarbital
Early seizures (1 to 7 days)
Immediate Sz Late
Dilantin
Carbamazepine
Phenobarbital
Levetiracetam
Have all been proven to be effective in decreasing the frequency of early pot-traumatic seizures, however none have shown the decrease the incidence of PTE
Trauma
7 days

28. Animals
Effect of treatment on the epileptogenesis after TBI in experimental models
Rimonabant sinngle dose6 wk Echegoyen et
Minozac 6 h post-TBI two doses7 d Chrzaszcz et al. 48
Ketogenic diet Schwartzkroin et
HypothermiaParasagittal FP30 min post-TBI for 4 h12 wk Atkins et al. 

29. Hypothermia
No studies in human

30. Magnesium
No studies in humans

31. Conclusions