Post-traumatic seizures and epilepsy
- Randolph W Evans, MD, FAAN
Randolph W Evans, MD, FAAN
- Clinical Professor of Neurology
- Baylor College of Medicine
- Steven C Schachter, MD
Steven C Schachter, MD
- Professor of Neurology
- Harvard Medical School
Seizures are a long recognized complication of traumatic brain injury (TBI). Seizures that occur early versus late after TBI have different implications for prognosis and management. Early seizures are felt to be acute symptomatic events with a low likelihood of recurrence, whereas late seizures represent epilepsy.
While only 4 percent of all epilepsy cases are attributed to trauma, 13 percent of those cases that are of known cause are post-traumatic . TBI is also the most important cause of symptomatic epilepsy in persons aged 15 to 24 years. Post-traumatic epilepsy contributes significantly to the functional disability in a TBI survivor.
This topic will discuss epidemiologic, clinical, management and prognostic issues that are specific to post-traumatic seizures. More general issues related to seizures and epilepsy are discussed elsewhere. (See "Overview of the management of epilepsy in adults".)
Early post-traumatic seizures are defined by their occurrence within one week of head trauma. These are acute symptomatic events and are not felt to represent epilepsy.
A distinct category of immediate seizures, those occurring upon or within seconds of impact, is controversial. Some feel that these are "convulsive concussions" and not epileptic events ; others include them in the category of early seizures because of their similar associated risk for post-traumatic epilepsy [3,4] (See 'Prognosis' below.)
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