People in dangerous jobs don't usually sleep well. New research is investigating if their susceptibility to concussions and poor sleep could put them at greater risk of developing epilepsy.
Known simply as "the seizure disorder," epilepsy affects millions around the world. FIU Assistant Professor Oleksii Shandra is researching how much someone's odds of developing epilepsy increase when they experience a specific one-two punch: first, a pattern of poor sleep; then, a traumatic brain injury.
The research, which has implications for people in dangerous jobs such as firefighters, athletes, truck drivers and more, is sponsored by a $758,808 grant from the Department of Defense's U.S. Army Medical Research and Development Command. The study will focus on implications for U.S. soldiers and veterans.
People in the military can sleep less than normal due to strenuous training and deployment to combat zones. They can also be prone to head injuries as they perform dangerous tasks, with their risks increasing even more if they are groggy, tired and struggling to focus, Shandra explains.
"The question is, when a person is experiencing chronic sleep disruption and then undergoes a traumatic brain injury, how much does their risk of developing epilepsy increase?" Shandra says. "This is a very important yet understudied question in our field. If we can identify the people who have a very high chance of developing epilepsy, we might be able to help them before the seizures arrive."
Epilepsy is known as a disease with many potential causes, ranging from genetics to metabolisms to infections. Shandra is focusing on the combination of poor sleep and head injuries in part because they are both so common.
More than 50% of U.S. armed services members receive six or less hours of sleep per night, according to Department of Defense data from 2005-2018. And according to the Traumatic Brain Injury Center of Excellence—a collaboration between the Department of Defense and Veterans Affairs — roughly 500,000 U.S. service members sustained a traumatic brain injury between 2000 and the first quarter of 2024.
The project builds upon Shandra's previous research in epilepsy diagnosis. While working as a senior research scientist on $2.6 million grant project at Virginia Tech, Shandra discovered electrographic biomarkers (specific patterns of brain electrical activity in mice with traumatic brain injury) that could predict the onset of epilepsy.
Shandra analyzed more than 24,000 hours' worth of EEG data in the research and mentored 20 students in the process.
"This served as a springboard into my current research," Shandra said. "Now that we know what patterns to look for after a traumatic brain injury, we can build on that research by studying the effects of chronic sleep disruption, too."
Sleep is essential to the normal functioning of the brain. Shandra hypothesizes that some of the negative effects of chronic sleep disruption and traumatic brain injuries might combine, leading to a higher risk of developing epilepsy.
His main focus is on the mechanisms in the brain that excite and inhibit electrical activity. Like a car, the brain has its 'engine' and its 'brakes' (scientifically known as excitatory glutamate and inhibitory GABA neurotransmission, respectively).
If the 'car' is running too fast and the 'brakes' cannot slow it down, an 'accident' — a seizure — can occur.
"A balance between the systems is crucial. Yet, this equilibrium is disrupted by traumatic brain injuries. I fear that sleep disruption prior to the injury will only exacerbate this imbalance," Shandra said.
If his hypothesis is correct, people who undergo these series of events will become prime candidates for preventative treatment. Shandra and a team of researchers are looking to see if a non-invasive method might help them.
Known as Transcranial Magnetic Stimulation, the treatment uses magnetic pulses to stimulate the brain's nerve cells. It is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression and might be helpful in repairing the 'braking system' of the brain, Shanda says.
Collaborators on the research include Professor Richard Staba, an expert on seizure dynamics and sleep neurophysiology at the University of California, Los Angeles, and Assistant Professor Rachel Rowe, an expert on the interplay between sleep and neuroinflammation at the University of Colorado, Boulder.
Also involved are Epilepsy Alliance Florida with its President and CEO Karren Basha Egozi, who performs epilepsy advocacy. Shandra's research is part of the Virtual Post-Traumatic Epilepsy Research Center, which is guided not only by experts in epilepsy research but also patients, military personnel and veterans living with epilepsy, who will serve as consultants while the research is ongoing.
"This is a powerful model. It allows us to transform our research in real time, making it more relevant and impactful to those living with post-traumatic epilepsy," Shandra says. "When we listen to the challenges they face, like disruptions in sleep, we can adjust our focus and deepen our understanding of those issues to better serve the epilepsy community."
Post-traumatic epilepsy remains a mysterious and unpredictable condition. Some individuals begin experiencing seizures shortly after a head injury, while others may go years without symptoms before epilepsy emerges. Shandra hopes his research will help reveal some of that uncertainty, bringing clarity and solutions to at least a portion of the millions worldwide living with epilepsy caused by traumatic brain injury.
Ingrid Hernandez contributed to this story.
