Understanding Post-traumatic Epilepsy: Symptoms and Treatment

Post-traumatic epilepsy is a condition that affects people who have traumatic brain injuries(TBIs). Up to 5% of individuals who suffer from TBI will develop PTE. It can significantly impact their quality of life. PTE can occur immediately after the injury or may take several years to develop.

Symptoms of PTE can vary widely and may include:

• seizures;
• memory problems;
• mood changes;
• difficulty concentrating.

These symptoms can be debilitating. They can significantly affect an individual’s ability to carry out daily activities.

Various treatment options are available for seizure after a head injury, including medication, surgery, and other therapies. But, finding the right treatment plan can be challenging. As each individual’s symptoms and response to treatment can differ.

In this article, we will explore the symptoms of PTE. Also, we will discuss the different treatment options available. We will also examine the question if concussions can cause epilepsy. You may also find tips for managing the condition.

Post-traumatic epilepsy definition

TBI seizures  is a chronic condition characterized by recurrent unprovoked epileptic seizures. They are causally linked to a history of brain injury (traumatic brain injury).

The incidence of PTE in previous traumatic brain injury cases is easily found in many studies to be 5-50%. And its course is often progenerative. It depends on the severity of the trauma and its complications. Doctors must make a clear description of post-traumatic seizures symptoms:

• Seizures that occur within 24 h after a traumatic brain injury are immediate. Of all seizures within the first week of craniocerebral trauma, about 50% occur within the first 24 h.
• Seizures that develop during the first week after injury are early. According to the study, early seizures occur in 2 to 17% of all trauma patients. They are more common in children than adults. And their frequency correlates with the severity of the trauma. Early seizures after severe traumatic brain injury are usually higher:

• 10 to 15% for adults; 
• 30 to 35% for children.

• Seizure after head injury with manifestation from day eight and after a traumatic event is late. The International League Against Epilepsy (ILAE) classifies immediate and early seizures as:

• “situationally conditioned”;
• “acute symptomatic.”

So they do not need a diagnosis of epilepsy.

It is reasonable to diagnose PTE only in persons with recurrent unprovoked SE. They had suffered head trauma more than seven days before the onset of SE. But a single SE after a CHT cannot be epilepsy. PTE forms:

• earlier after a severe concussion (about a year later);
• later (two years or more) after a concussion.

The main risk factors for TBI seizures, according to studies, are: 

• age less than five years;
• severe degree of trauma;
• penetrating trauma;
• intracranial hematoma requiring neurosurgical intervention;
• linear or depressed skull fracture;
• hemorrhagic brain contusion;
• coma lasting more than 24 hours;
• early post-traumatic seizures;
• focal changes on neuroimaging or EEG during the acute period of trauma.

Post-traumatic seizures symptoms

The most characteristic manifestation of epilepsy following a brain injury is seizures. Most often, they occur after:

• stressful situations;
• ingestion of alcohol;
• physical overload.

Symptoms in seizures usually depend on which brain area has pathological activity.

Seizures can occur in specific muscle groups. They spread in a sequence. It corresponds to the location of motor centers in the precentral gyrus. The seizure proceeds without loss of consciousness.

After the seizure, paresis of the limb in which the seizure occurred is present.

At the height of the seizure, the patient may:

• lose consciousness;
• generalized convulsions develop. 

Changes in vision, hearing or other senses may also occur during post-traumatic epilepsy. The individual may experience:

• visual or auditory hallucinations;
• changes in their sense of touch or taste. 

They may also experience a sensation of numbness or tingling in their limbs. Another variant of a seizure is local paresthesias.

Besides convulsive seizures in such patients are present:

• mental disturbances.
• instability of character.
• lability of mood.
• weakening of memory.
• impaired criticism.
• progressive dementia.

Often, precursor symptoms of a painful condition occur before an attack. These are called the aura.

Common manifestations of the aura are:

• nausea;
• severe anxiety for no clear reason;
• poor appetite;
• pain in the stomach;
• insomnia;
• headache;
• severe irritability.

It is important to note that not all individuals who experience TBI seizures will develop PTS. But, people who have experienced a TBI are at a higher risk of developing seizures. That’s why they should seek medical attention if they experience any described symptoms.

How can concussions cause epilepsy? 

It can occur as they damage the brain in ways that make it more susceptible to seizures. A concussion is a type of seizure after head injury:

• It occurs when the brain is pushed or concussed inside the skull.
• It can cause the brain to swell or bleed, leading to brain activity and connectivity changes.

One of the ways concussions can lead to epilepsy is by causing the formation of scar tissue in the brain. Scar tissue can disrupt the brain’s normal functioning:

• It creates areas of abnormal electrical activity that can trigger seizures. This type of epilepsy is known as post-traumatic epilepsy (PTE). 
• It can develop months or even years after the initial concussion.

Another way concussions can cause epilepsy is by altering the brain’s chemical balance. A concussion can cause an increase in the production of certain chemicals in the brain. For example, it can be glutamate, which can cause damage to brain cells and increase the risk of seizures. 

The severity and frequency of concussions can increase the likelihood of developing epilepsy.

What to do with a seizure after a head injury? 

Taking specific steps to ensure their safety is essential after a seizure. Here are some steps you can take:

1. Ensure safety. The priority is to protect the person from harm. So remove any sharp or dangerous objects nearby that may cause injury. Also, make sure there are no hard surfaces or sharp corners nearby.
2. Ease the person to the ground. Gently guide them to the ground so they don’t fall, hit their head, or cause harm.
3. Loosen any tight clothing. If the person is wearing tight clothing, such as a belt or tie, loosen them. You need it to ensure they can breathe comfortably during post-traumatic epilepsy.
4. Turn the person to the side. This can help prevent choking or aspiration if the person vomits or has much saliva in their mouth. It also helps clear their airway to breathe more easily.
5. Do not restrain the person. Although watching someone having a seizure can be distressing, do not restrain them. As it can cause further injury.
6. Time the seizure. It’s important to time the seizure as it can help medical professionals understand the severity and length of the seizure.
7. Seek medical attention. Call for emergency medical services or take the person to the nearest hospital very fast. Do it, especially if:

• the seizure lasts longer than 5 minutes;
• the person has multiple TBI seizures;
• they experience breathing difficulties.

1. Reassure the person. If the person is conscious, reassure them that they are safe and that you are there to help them.
2. Provide relevant information to medical professionals. Be sure to inform medical professionals about the head injury and any other relevant medical history, such as whether the person has a history of seizures or epilepsy.
3. Follow-up with medical care. After medical attention, following up with the person’s healthcare provider is important. The healthcare provider can recommend tests to determine the extent of the injury. Also, they may prescribe medication or other treatments.

In summary, the most important thing to remember when dealing with a seizure after a head injury  is to prioritize the person’s safety and seek medical attention immediately. Keep calm, reassure the person and follow the advice of medical professionals. Remember that you can find a high-qualified medical help from Lone Star Neurology.

FAQ 

• Does post-traumatic epilepsy go away?

No, post-traumatic epilepsy may not go away completely. It can be a lifelong condition that requires ongoing management. While some people may experience spontaneous remission, for others, post-traumatic epilepsy can be a lifelong condition that requires ongoing management with medication and other therapies.

• How is post-traumatic epilepsy diagnosed?

The doctor diagnoses it by analyzing the history of trauma that led to the disease and data on how often seizures occur, what triggers them, and how long they last. EEG or electroencephalography records brain biopotentials, and MRI of the brain are assigned as instrumental examinations.

• What are post-traumatic seizures?

Post-traumatic seizures can occur after a traumatic brain injury (TBI). They may occur within the first few days after the injury or weeks to months later. Post-traumatic seizures are a common complication of TBI, affecting around 5% to 7% of people who have suffered a traumatic brain injury.

• Can post-traumatic epilepsy develop immediately after a head injury?

No, post-traumatic epilepsy may not develop immediately after a head injury. It can occur weeks, months, or even years after the injury, making it important to monitor for symptoms and seek medical attention if they occur.