Epilepsy as a Result of a Head Injury

Welcome to the TBI-HELP Live Chat

Today's topic is: "Epilepsy as a Result of a Head Injury"

Our Guest is: Dr. Daniel Luciano, Director of Clinical Epilepsy Program, Epilpsey Center

[19:01:00] Mod: Good Evening and welcome to our live moderated chat session. Tonight we have as our guest speaker Dr. Daniel Luciano, Director of Clinical Epilepsy at the Epilepsy Center at NYU Mt. Sinai Medical Center, New York. Welcome Dr. Luciano..
[19:02:19] DrDanielLuciano: Thank you. It's a pleasure to be here.
[19:02:43] Mod: How can Epilepsy develop?
[19:03:44] DrDanielLuciano: Epilepsy develops as a result of trauma to the brain with scarring as a result of factors such as bleeding. It can take some time for the seizures to develop as changes in the structure of the brain are required.
[19:05:01] Mod: Rail: Given the nature of a TBI - how can you tell that epilepsy is present?..
[19:05:41] DrDanielLuciano: It is based upon the occurrence of seizures as well as findings on testing such as electroencephalograms.
[19:06:00] Mod: Does only severe brain injury cause epilepsy?..
[19:06:58] DrDanielLuciano: No. Though the greater the severity of the injury the greater the chance of epilepsy, there are clearly cases of relatively minor head injury that result in epilepsy. The base of the brain under the frontal lobes and the temporal lobes seem to be particularly likely to develop seizures after trauma. The results of large population-based studies at the Mayo Clinic and elsewhere have found that mild head trauma does not have a significant risk of epilepsy. Such data is used by lawyers, insurance companies, etc., to say that seizures in mild injury are not due to the trauma, but I beg to differ.
[19:09:54] Mod: Rail: What actually causes Epilepsy?
[19:10:28] DrDanielLuciano: Epilepsy is a disorder that can be caused by many factors. Some are inherited, some may be due to chemical imbalances, and the largest group are those with some type of scar on the brain. It is actually an electrical storm within the nerves which may stay local or spread, causing all the nerves to act in unison, which is abnormal.
[19:12:28] Mod: What factors about the injury are associated with a higher of developing epilepsy?
[19:12:49] DrDanielLuciano: Greater severity of the injury carries a greater risk. Such factors include penetrating skull fractures, penetration of the dura (covering of the brain), hemorrhage and persistent neurological abnormalities. Another factor associated with epilepsy is the occurrence of an "early" seizure- within the first week after injury.
[19:15:32] Mod: Steve: Is the brain more capable of dealing with epilepsy with increasing age?
[19:16:05] DrDanielLuciano: Actually, the young brain may be better able to adapt as the juvenile brain is very plastic. Functions in a young child can change location and result in lsser deficit as compared to an older person.
[19:17:29] Mod: Rail: Should every seizure after TBI be called Epilepsy?
[19:17:59] DrDanielLuciano: Epilepsy, by definition, is two or more unprovoked seizures. As a result, a single seizure cannot be called epilepsy. Even repeated seizures that have a cause, such as low blood sugar, are not epilepsy, but a seizure disorder related to low glucose.
[19:18:58] Mod: Steve: I have heard that in some cases, the involved part of the brain that causes epilepsy can be treated by surgical removal. Is this true and how effective is this?
[19:19:41] DrDanielLuciano: Yes, that is true. In fact, at our NYU-Mt. Sinai program we do more epilepsy surgery than anywhere in the country. The effectiveness is dependent upon the region involved. Those with temporal lobe epilepsy have the greatest likelihood of cure (70-80%), as well as those with an MRI abnormality.
[19:21:16] Mod: Rail: Are there seizures that can be life threatening after TBI?
[19:21:52] DrDanielLuciano: Grand mal seizures (tonic-clonic) carry the greatest risk due to injuries as well as compromise of breathing. The other types, such as complex partial (temporal lobe) with staring are much less dangerous.
[19:22:26] Mod: Rail: Are you using Functional MRI to assist you in the Epilepsy Surgery?
[19:23:04] DrDanielLuciano: Yes we are. We have generally had to directly stimulate the brain to find important areas, such as those for speech or motor control. Now we can prevent an invasive study by using the functional MRI, though some of this is still experimental.
[19:25:02] Mod: Dr. Luciano are you currently publishing anything on epilepsy that can be of use for the caregiver and families of epileptic patients?
[19:25:22] DrDanielLuciano: I have been publishing a number of book chapters recently concerning the psychiatric manifestations of epilepsy, as well as the adverse effects of anti-epileptic drugs. I personally do not have a "guide" for epilepsy published.
[19:26:25] Mod: Does a seizure at the time of an injury indicate the patient will have epilepsy?
[19:26:59] DrDanielLuciano: No. Such "contact" seizures have a much lesser chance of developing into chronic epilepsy. They may just be due to immediate traumatic effects upon the brain.
[19:28:26] Mod: When does post traumatic epilepsy (PTE) develop?
[19:28:43] DrDanielLuciano: Interestingly, epilepsy often does not develop immediately, but after a lag time og at least 6-12 months.This is due to the fact that changes in cellular architecture mus take place in the brain in order for the seizures to develop. This is often very important in legal cases, as quick settlements may not take delayed consequences such as this into account.
[19:30:16] Mod: Unknown visitor: Well, doctor it is very interesting that you have published something describing the effects of these drugs and the brain. This is very important. Now if I would want to look at this how can I get a copy?
[19:30:56] DrDanielLuciano: It is presently in publication and shouls be out within a few months. If you provide your address, I can make you a copy.
[19:33:29] Mod: Are seizures episodes of staring or shaking?
[19:34:09] DrDanielLuciano: They can be, but most people, including many good doctors, don't realize that ANYTHING can be a seizure. Seizures can consist of only forced thoughts or recurrent memories, episodes of panic (misdiagnosed and sent to psychiatrists) or even the feeling that someone is standing behind your shoulder (misdiagnosed as paranoia). Often the EEGs in such patients may be normal, since the areas of trauma are deep in the temporal or frontal lobes, and doctors then think the patients are only "crazy". Anything, no matter how weird, may be a seizure if it is of the same character and duration each time it occurs.
[19:37:05] Mod: Patricia, I will ask Dr. Luciano to mail a copy to me and then I will forward it to you. Please e-mail our site with your address so I can do so. Thank you.
[19:37:24] Mod: Patricia: When can epilepsy strike?
[19:38:12] DrDanielLuciano: It can occur at any point in life. 10% of us will have a seizure during our lives, though the incidence of epilepsy is 0.5-1%. It is more common in young children and in the lederly.
[19:38:56] Mod: Does an abnormal EEG mean that an episode is a seizure?
[19:39:28] DrDanielLuciano: It may, but as many as 10% of "normals" may have epileptic activity in their EEG. Sometimes this leads doctors to treat people for epilepsy when the problem represents something else, such as fainting or panic. Many patients with TBI will have abnormal EEGs, but this doesn't necessarily mean they have seizures.
[19:41:12] Mod: Should all patients with brain injury be given antiepileptic medications in order to prevent the development of epilepsy?
[19:41:55] DrDanielLuciano: No. Many patients with brain injury are given anti-epileptic medication with this in mind.
[19:42:02] Mod: Please remember that this is the opinion of Dr. Luciano. Please always remember to check with your own Doctor regarding any medications or problems. Thank you.
[19:42:32] DrDanielLuciano: However, there is no proof to date that such medications prevent the development of epilepsy, let alone prevent a seizure from occurring. In America many patients are automatically given such medications because it has been "standard of practice". However, in Great Britain they have reacted to the data that exists and do not treat with such medications until a person has experienced a seizure. However, if there is a very great risk of seizures, most of us would treat. Also, if someone tells me they will be driving and are at great risk I will treat.
[19:44:54] Mod: Patleem: Dr. Luciano, can a person turn out epileptic because of pre-existing conditions originating from the womb or prenatal complications. If so, do you know of any studies that support this?
[19:45:24] DrDanielLuciano: Yes, and this is not uncommon. There are many cases we see where there is prenatal compromise or injury during birth which results in seizures. I cannot quote you a specific article at present.
[19:46:31] Mod: Rail: Do the medications mask some of the TBI patient's important symptoms-that may delay or interrupt the return toward normalcy?
[19:47:28] DrDanielLuciano: This is an important point. Some of these medications may negatively affect concentration, memory and mood, contributing to any underlying dysfunction form the brain injury. This is one of the big reasons why such patients should not be given these medications unnecessarily.
[19:48:56] Mod: What effects does epilepsy have on a patients life?
[19:49:58] DrDanielLuciano: There are a number of problems. There is first the risk of seizures and any injury that may occur with it, as well as the fear of experiencing a seizure. There are also the side-effects of anti-epileptic medications. There may be feelings of dependency as there are restrictions on activities such as driving. Also, recreation may be limited (scuba diving, sky diving, etc.). Finally, employment may be a problem. Though the law protects those with epilepsy from discrimination, employers find ways around it.
[19:52:18] Mod: Rail: What new treatments are emerging that can help in TBI related epilepsy - Does the "stem cell" research have a potential application here???
[19:52:46] DrDanielLuciano: There are a number of new treatments and it is an exciting time in epilepsy. We have many new drugs which are much safer and better tolerated. There are also a number of brain stimulating devices, such as the vagus nerve stimulator, which are very helpful. Yes, there may be a role for stem cell treatment. In fact, there are preliminary studies which are promising which hae implanted such cells into the region producing epilepsy with some promising results.
[19:55:25] Mod: Patleem: How does epilepsy affect the person's sexual life/
[19:56:33] DrDanielLuciano: Epilepsy itself, as well as some of the medications, generally lead most commonly to "hyposexuality"- decreased interest in sex. Some of this may be related to hormonal changes in the brain caused by the seizures or drugs, and some may be due to the drugs changing levels of sex hormones.
[19:57:19] Mod: Well, it looks like our time is up. I want to thank Dr. Luciano for a most interesting and informative evening. I would like to invite him to return as a guest speaker in the future. Thank you Dr. Luciano. Thank you all for participating in tonight chat and I look forward to seeing you next week. Be safe and have a wonderful week. Good night.
[19:58:02] DrDanielLuciano: Thank you very much for having me. It was a great experience and I hope I was helpful.