Veterans who develop epilepsy following a traumatic brain injury (TBI) face a higher risk of death than veterans with epilepsy from other causes. That's according to a study led by researchers at Baylor College of Medicine.
The findings, published in Neurology, showed that those with post-traumatic epilepsy were 2% more likely to die compared to veterans with non-traumatic epilepsy.
"While the increase in risk may seem modest at first glance, it is substantial when you consider we are comparing against a population already at high risk of mortality," said senior author Dr. Zulfi Haneef, professor of neurology at Baylor and the Center Director of the Epilepsy Center of Excellence at the Michael E. DeBakey VA Hospital. "That makes this finding all the more concerning."
Researchers analyzed data from more than 210,000 veterans with epilepsy, of which 28,832 had experienced a TBI in the five years prior to their diagnosis.
The study also found that younger veterans aged 18-39 with extracerebral injuries, those outside the brain but still affecting brain function, had a two-fold increase in mortality compared to other young adults with epilepsy not related to trauma.
The risk also varied based on the cause of the traumatic brain injury. Those with skull or facial fractures had an 18% higher risk of death during the study period; those with diffuse brain injury that affects the brain's network of nerve fibers, had a 17% higher risk; and those with localized brain injury had a 16% higher risk.
"This is a particularly vulnerable group," said Rohan Nagabhirava, a second-year student at Baylor's School of Medicine - Temple campus and the primary author of the study. "They may appear outwardly healthy, but the long-term consequences of traumatic brain injury can be serious, even fatal."
One surprising finding Nagabhirava found was that veterans who developed epilepsy after a concussion appeared to have lower mortality compared to other epilepsy patients. However, researchers cautioned that this finding reflects comparison to a high-risk epilepsy population, not the general healthy population.
"Overall, the findings underscore the need for early detection, aggressive treatment and ongoing monitoring for veterans with a history of TBI," said Haneef, who also is a fellow of the American Academy of Neurology. "If epilepsy is diagnosed, treatment should be prompt and tailored to each individual's risk factors. Future studies are needed to increase our understanding and to draw more attention to this often-overlooked population."
The study was funded by the U.S. Department of Defense and used data from the Veterans Health Administration.
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