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Wednesday, August 3, 2011

Post Traumatic Brain Injury Seizures

In an effort to educate myself on the new trauma in our lives (seizures) I decided to do a little research. Something interesting for your gee-whiz collection.

Approximately 5-10% of individuals with traumatic brain injury (TBI) experience new- onset seizures. The risk of seizure increases with increasing injury severity, depressed skull fracture, intracranial hematoma, and penetrating trauma (Mark has all of these). The risk is greatest in the first two years after injury and gradually declines thereafter. All types of seizures may occur as a result of trauma, but the most frequent are focal or partial complex seizures. Generalized complex seizures (what are commonly called "grand mal' seizures) occur in approximately 33% of cases. (Mark's was a grand mal)

Immediate onset seizures, those that occur immediately or in the first few hours after a brain injury, do not suggest a chronic seizure disorder. Early onset seizures and those which develop within the first 7-8 days after trauma require prophylaxis for up to one year. Spontaneous resolution of seizure activity has been noted in this group. The highest risk group for persisting seizures are those individuals who experience seizure 7-8 days or longer following injury. Current recommendations for seizure prophylaxis suggest that patients who have not suffered a seizure within the first 7-8 days following a closed head injury, probably do not require prophylaxis. (Which is why Mark wasn't prescribed medication until he had an actual seizure)

Penetrating trauma is another issue entirely, particularly if involving the temporal or frontal lobes. (Mark has substantial temporal lobe damage) The guidelines with respect to early onset seizures and medications do not apply in this group. Current thinking is that prophylaxis with anti-convulsant medication is not necessary if seizures have not occurred. It should be kept in mind that most seizures do not result in increased brain injury and status epilepticus is a rare event. The protection afforded by medication must always be balanced with the effects on cognition and other side effects, such as bone marrow depression, liver toxicity, or diminished motor coordination.

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