Research Reports - Risk of severe and repetitive traumatic brain injury in persons with epilepsy

Epilepsy Behav. 2014 Jan 24

Wilson DA(1), Selassie AW(2)

BACKGROUND: While traumatic brain injury (TBI) can lead to epilepsy, individuals
with preexisting epilepsy or seizure disorder (ESD), depending on the type of
epilepsy and the degree of seizure control, may have a greater risk of TBI from
seizure activity or medication side effects. The joint occurrence of ESD and TBI
can complicate recovery as signs and symptoms of TBI may be mistaken for
postictal effects. Those with ESD are predicted to experience more deleterious
outcomes either because of having a more severe TBI or because of the cumulative
effects of repetitive TBI.
METHODS: We conducted a case-control study of all emergency department visits and
hospital discharges for TBI from 1998 through 2011 in a statewide population. The
severity of TBI, repetitive TBI, and other demographic and clinical
characteristics were compared between persons with TBI with preexisting ESD
(cases) and those without (controls). Significant differences in proportions were
evaluated with confidence intervals. Logistic regression was used to examine the
association of the independent variables with ESD.
RESULTS: During the study period, 236,164 individuals sustained TBI, 5646 (2.4%)
of which had preexisting ESD. After adjustment for demographic and clinical
characteristics, cases were more likely to have sustained a severe TBI (OR=1.49;
95% CI=1.38-1.60) and have had repetitive TBI (OR=1.54; 95% CI=1.41-1.69).
CONCLUSION: The consequences of TBI may be greater in individuals with ESD owing
to the potential for a more severe or repetitive TBI. Seizure control is
paramount, and aggressive management of comorbid conditions among persons with
ESD and increased awareness of the hazard of repetitive TBI is warranted.
Furthermore, future studies are needed to examine the long-term outcomes of cases
in comparison with controls to determine if the higher risk of severe or
repetitive TBI translates into permanent deficits.

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