TRAUMATIC BRAIN INJURY AND SUBSEQUENT DEVELOPMENT OF EPILEPSY 12/27/06

A standard protocol of treatment for moderate to severe traumatic brain injury in patients within the first week post-trauma is the administration of propalactic anti-convulsants in order to lower the risk of subsequent seizures. Hospitalized patients with coma states may actually present more difficulty in the recognition of seizure events than non-hospitalized conscious patients. T.B.I. patients are at a greater risk of developing epilepsy than age-matched controls (risk factor increase of 6.9%). T.B.I. patients who have one or more seizures during the first week post-injury are at a greater risk of developing epilepsy than those who do not (risk factor increase of 8%). Other risk factors [only one needs to be present] quoted in the same article are:

• focal signs (as seen by neuroimaging techniques) at the first examination
• missile injuries
• frontal lesions
• intracerebral haemorrhage
• diffuse contusion
• prolonged post-traumatic amnesia
• depression fracture
• cortical-subcortical lesions.

Although folks with mild Traumatic Brain Injury [i.e. not life-threatening, yet still may be life-altering] have less of a risk of developing epilepsy than those whose T.B.I. is diagnosed as moderate or severe, education on how seizures may manifest should be provided. Typical signs of seizure activity in those with mT.B.I.-- from the same article-- may include:

• focal clonic activity of an extremity or hemibody
• eyelid fluttering
• lip smacking
• episodic staring associated with motor automatisms.

sapphoq healing tbi says: The importance of observation of the mT.B.I.-er for possible seizure states needs to be stressed and included in emergency room aftercare instructions. Specific examples like those provided in the article are more helpful to carers than no examples at all [or no instructions given regarding these things, as in my own case] or the suggestion to return to the e.r. if the mT.B.I.-er is difficult to arouse.

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The December Annual Meeting of the American Epilepsy Society saw the presentation of a number of significant papers on epilepsy including the recognition of a biomarker as a predictor for T.L.E. in studies of animals with brain injury, a link between the control of epilepsy fostered by treatment of sleep apnea [present in 47% of epileptics and in 50% of T.B.Iers], and the effectiveness of brain surgery in alleviating T.L.E. seizure states.

Medscape has resource centers devoted to various medical conditions, including one on epilepsy which can be found here.


http://www.medscape.com/viewarticle/549299
"Currently, there are no reliable surrogate markers for epilepsy, which is one of the holy grails in all diseases. Right now we use interictal EEG spikes [to diagnose epilepsy], but they tend to be nonspecific and don't indicate where seizures originate, so they are less than ideal," Dr. Engel told Medscape.

Animal models of temporal lobe epilepsy (TLE), as well as human data, show that fast ripples are specific to the area of the brain that generates seizures. Furthermore, said Dr. Engel, research has also shown fast ripples correlate with the severity of epilepsy and are able to predict which animals will develop seizures following brain injury. [end of quote]
from 12/12/06 article by Caroline Cassells Fast Ripples Making Waves as First Reliable Biomarker for Epilepsy



http://www.medscape.com/viewarticle/548724
According to Dr. Malow, a growing recognition among the scientific community of a definite link between OSA and epilepsy led to the study.

One possible explanation for poor-quality sleep in individuals with epilepsy may be the tendency to have sedentary lifestyles and daytime sleepiness, effects that are frequently attributed to the sedating effects of antiepileptic drugs (AEDs).

Whatever the reason, she added, research suggests that poor-quality sleep can lead to increased seizures. While the mechanism is not entirely clear, the current thinking is that sleep deprivation increases neuronal excitability, which in turn triggers and increases seizure frequency. [end of quote]
from 12/4/06 article by Caroline Cassells Treating Sleep Apnea May Reduce Seizure Frequency in Refractory Epilepsy

http://www.medscape.com/viewarticle/549196/
Yet, despite enhanced treatment options, many patients are not offered advanced therapies, including epilepsy surgery, even though it can offer patients with temporal lobe epilepsy about an 80% chance of becoming seizure-free. [end of quote]
from 12/12/06 article by Caroline Cassells Neurologists May Underrecognize, Undertreat Epilepsy

Other news from the

First North American Regional Epilepsy Congress: 60th Annual Meeting of the American Epilepsy Society
December 1 - 5, 2006, San Diego, California

This concludes a brief review of recent epilepsy news on http://www.medscape.com/ .

sapphoq healing t.b.i.