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Post traumatic epilepsy discussed by Dr. Enrique Feoli-Feature article

Head injury is a known cause of epilepsy. A number of factors can lower the seizure threshold and result in post-traumatic seizures (PTS).

In this issue, we sat down with Dr. Enrique Feoli, epileptologist, Associate Director of Northeast Regional Epilepsy Group International Branch and Co-director of the Northeast Regional Epilepsy Group in Hackensack, New Jersey.  Dr. Feoli earned his medical degree at National University of Cordoba Medical School in Argentina.  He then came to the USA and went on to complete his training in neurology and epilepsy in the following medical centers: Internship at the Bronx Lebanon Medical Center, Residency at New York University Medical Center and Fellowships at New York University Medical Center and New York Presbyterian Hospital, Cornell Campus.  In recent years, he has developed a particular interest in post-traumatic epilepsy (PTE) and was part of the American Epilepsy Society's Special Interest Group in PTE while it was meeting

Is it true that someone can develop epilepsy from a head injury?  If so, what kinds of injuries might cause post traumatic epilepsy?

Yes, you can certainly develop epilepsy from a head Injury. Understandably, injuries that are most likely to cause epilepsy are those that cause the greatest brain damage.  Example of this would be a head trauma with a depressed skull fracture,  gunshot wounds, among others. Another important risk factor is that those whose age is more than 65 years are at greater risk of developing PTE.  In addition, seizures occurring soon after the head trauma happened, increase the possibility of developing epilepsy from this traumatic brain injury (TBI). 

Can you explain how head trauma can lead to epilepsy? Are there mechanical or chemical changes to the brain?

The pathophysiology as to how head trauma causes epilepsy is not well understood. This is a key question that researchers are seeking to answer because  once we do know how this works, we can use that knowledge to potentially prevent post-traumatic epilepsy. 

Some of the existing theories are that blood damages the brain tissue and the scar left behind causes epilepsy.  Others propose that the release of neurotransmitters  (glutamate) causes the neurons to fire excessively, leading to toxicity, and then epilepsy.  There are also personal and genetic factors that likely play a role in who will develop PTE. 

Is post traumatic epilepsy the same as post traumatic seizure? Does everyone who experiences a post traumatic seizure develop post traumatic epilepsy?

No, post traumatic seizures (PTS) and post traumatic epilepsy (PTE) are not the same.  Post traumatic seizures are seizures that occur immediately after the trauma and up to a week following the trauma.  On the other hand, post traumatic epilepsy (PTE) is defined as  one or more seizures that occur at least a week after the TBI.

An important thing to remember is that not everyone who experiences post traumatic seizures go on to develop epilepsy.  Of the patients who experience post traumatic seizures, only around 20 % go on to develop epilepsy. 

How many people in the US are estimated to have post traumatic epilepsy?  Are there more men or women who have this?  Are there certain ages, occupations, or ethnicities that have a higher risk of this?

It is estimated that TBI is an etiological factor in up to 20% of symptomatic epilepsies in the general population.  Men and women are equally affected so gender is not in itself a risk factor.  However, there may be some occupational risks (e.g. military, construction) that can increase the risk of head injuries and PTE.  There are no noted differences in ethnicities. However, age is a factor as I said earlier.  Those who are 65 or older at the time of the head trauma have an increased likelihood of developing epilepsy. 

How is post traumatic epilepsy diagnosed?

Epilepsy is a clinical diagnosis that requires 2 or more seizures in someone who has a history of head trauma.  That is how one makes the diagnosis.

A brain MRI is utilized to see the extent of the brain damage.  EEG may also be necessary for the differential diagnosis. 

How is post traumatic epilepsy treated? Is it different than other forms of epilepsy? Are there specific drugs that seem to be more effective? Would surgery be a possibility?

PTE is treated the same as other epilepsies. Usually only one medication is employed. However, if that fails, then a combination of medicines may be used. There are no drugs that are more effective than others in treating PTE.

Epilepsy surgery would be beneficial in refractory patients that have lesions that are amenable to surgical correction. 

And very important, what sorts of preventive measures do you recommend?  Wearing helmets, car seats, avoiding certain activities?  

Prevention of head trauma is extremely important, not only to prevent epilepsy but also other neurological disorders associated to head trauma, such as chronic traumatic encephalopathy (CTE).  According to the Centers for Disease Control (CDC), in 2013 there were 2.8 million ER visits due to TBI.  The leading causes of TBI were falls, being struck by or against an object and motor vehicle accidents.


I recommend parents use car seats and that these are placed in the appropriate location depending on the child's age. 

I strongly recommend that everyone should wear a helmet and make sure your children wear helmets when:

- Riding a bicycle, motorcycle, snowmobile, scooter, or all-terrain vehicle;

- Playing a contact sport, such as football, ice hockey, or boxing;

- Using in-line skates or riding a skateboard;

- Batting and running bases in baseball or softball;

- Riding a horse; or

- Skiing or snowboarding

When we consider safety for senior citizens, it is very important to make sure living areas are safety proofed by:

- Removing tripping hazards such as throw rugs and clutter where the person will be walking;

- Using nonslip mats in the bathtub and on shower floors

- Installing grab bars next to the toilet and in the tub or shower and handrails on both sides of stairways;

Last, but not least, we can make living areas safer for children, by:

- Installing window guards to keep young children from falling out of open windows in the higher stories of a property; and

- Using safety gates at the top and bottom of stairs to avoid tumbles down the stairs.

- Making sure the surface on your child's playground is made of shock-absorbing material, such as hardwood mulch or sand.

Thanks so much, Dr. Feoli for talking to us about this important type of epilepsy and especially for all the recommendations to keep in mind to ensure safety and prevent injuries. 

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