Post Traumatic Epilepsy
Nitin K Sethi, MD
Assistant Professor of Neurology
New York-Presbyterian Hospital
Weill Cornell Medical Center
New York, NY 10065
In this post I shall discuss the entity called post traumatic epilepsy/ post traumatic seizure disorder. Epilepsy is a condition characterized by two or more seizures in a person’s lifetime. Broadly speaking epilepsy can be of two kinds:
1. Primary Epilepsy
2. Secondary Epilepsy
Patients who have primary epilepsy have seizures usually due to an underlying genetic predisposition. They do not have a secondary cause for their seizures and neuroimaging is usually normal. On the other hands patients who have secondary epilepsy usually have seizures secondary to something (example secondary to brain tumor, secondary to an abscess in the brain, after a stroke and so forth). Under this category of secondary epilepsies is included post traumatic epilepsy (as the name suggests patients have seizures secondary to brain trauma).
Let me explain with the aid of an example. Let us assume our patient (we shall call him Philip) is a 27-year-old healthy male with no significant medical or surgical history. Bikes are his passion especially Harleys. Have you seen the ones they show on American Chopper. But we are digressing from our story line. Philip loves to ride them fast. A bright sunny Sunday morning finds him zipping down FDR drive at 80 mph. With a bike under me, I felt like a real man. And then disaster strikes. Philip’s bike gets clipped by a speeding SUV. Philip is flung from the bike and hits the ground hard. Did I mention he was not wearing a helmet at this time. He is rushed to the nearest hospital. A lacerated spleen, couple of broken ribs and a fractured collar bone. Not too bad you might say. He shall live to ride another day. But all is not so rosy. Philip does not regain consciousness and does not respond to verbal commands. A quick CT scan yields the answer. Philip has suffered extensive bleeding in the brain (neuro trauma). He is admitted to the neurological ICU. Recovery is painfully slow and after a months stay in the hospital, Philip is discharged to a sub-acute rehab facility. Alls well that ends well? Not quite done yet, I am afraid. Six months after his motorbike accident, Philip is again rushed back to the hospital after a witnessed tonic clonic convulsion. He is evaluated by a neurologist (like me) and a diagnosis of post traumatic epilepsy is made.
So what exactly is post traumatic epilepsy? As the name suggests epilepsy develops after head injury. Seizures can occur anytime after head injury. If they occur immediately after head injury it is referred to as immediate post traumatic epilepsy (also called impact seizures, as seizures occur at the time of impact to head). If seizures occur within the first month after head injury it is referred to as early post traumatic epilepsy. Patients may have their first seizure as long as 18 months after head trauma. This is referred to as late post traumatic epilepsy.
Patients develop post traumatic epilepsy as a result of scarring of brain tissue. They usually have convulsions. The treatment of post traumatic epilepsy is essentially the same as that of any other type of epilepsy. Once the seizure type is characterized, the right anti-epileptic drug is usually effective in controlling the seizures.
Braindisease's Weblog 
I had Dengue in 2000 (non-hemoragic). In 2002 I was diagnosed with Hemochromatosis and treated with twice weekly for several months and about 8 grams of Iron were removed.
MRI’s in 2007/2009 have shown “innumerable white matter lesions”. 2007 to 2009 MRI’s look about the same.
I seem to function well enough and am in a Masters program.
Whatever the cause of such widespread WML, is the brain plastic enough by deal with such widespread WML?
I am 54, male.
Dear Bruce,
thank you for writing in. You ask a good question and I am afraid I do not have a definite answer. In some disease states, there is excessive iron deposition in the brain. This though occurs in specific areas of the brain especially in parts of the brain referred to as basal ganglia. What is the cause of such wide spread WMLs in your case, I am not sure of. Patients who have risk factors for microvascular disease such as diabetes and hypertension and those who smoke frequently have WMLs.
Suprisingly more often than not, these lesions are clinically silent. Patients and doctors are not aware of them till a MRI scan reveals them.
Personal Regards,
Nitin Sethi, MD
Hi there Merely Me,
I was wondering how you were doing. Have not heard from your end in ages. Hope all is good with you and family.
Personal Regards,
Nitin Sethi, MD
Hi Dr. Sethi. I am a 34 year old female diagnosed with epilepsy. I had my first seizure at age 21. I am taking Tegretol. I have grand mal seizures. Before my first seizure, I hit my head hard a few weeks back and was temporarily confused. I had an MRI, MRA & PET Scan done. All results are normal. I can’t help but think if my seizures are due to the head accident I sustained. If my laboratory results are normal, is it safe to rule our the possibility that my seizures were caused by my head accident
Hello Trevor, It has been my experience that injuries such as yours can displace the C1 vertebra and directly affect the brain stem and various central nervous functions. While studying for certification in whiplash and spinal injury due to trauma sustained in auto accidents I found that Neurologists who are familiar with the studies of White and Panjabi regarding C1 displacement were referring patients to Atlas-Orthogonal Chiropractors. This specialized group of chiropractic physicians utilize physics and engineering principles to analyze and correct the position of C1 through a very specific adjustment with a percussive wave. There is no manual adjusting done. The studies reported significant improvements for these patients.
Hello, I had a head injury 1.5 year ago. i took a fall down a set of stairs, this kept me in the hospital for one week. My skull had a fracture and my brain bled, i was back to work etc 2 months later. About 2 months ago i had my first seizure. The doc put me on keppra, i fought against the drug and I slowly stopped taking it with Doc’s approval. Less than 2 months after my first seizure i had the second seizure, allowing to become too dehydrated seems to be the common trigger in both events. I am now taking keppra again, and hoping that I can get this under control so that i can return to driving and my job.
Any suggestions?
Dear Andrew,
only a few words of advice. At present stay on the anticonvulsant and do not be in rush to get off it. Your doctor shall be the best person to determine how long anticonvulsant therapy is warranted. If you experience any side-effects from taking the medication, bring it to his attention.
Nitin K Sethi, MD
Hello Dr. Sethi,
My son, 6, 5 years old, hurt his head while playing. The following day, when he woke up in the morning he was complaining of stomach aches. He had all the symptoms of flu due to high temperature (38.3 C). In the morning around 9 o’clock he drank a cup of hot chocolate. Around 11, as he was dining, he complained of dizziness and nausea. My wife picked him up to lay him down in couch, and by the time she laid him down he fainted. This lasted for around 1-2 minutes. When he became consciousness he vomited and we also noticed that he had urinated while he was unconsciousness.
We took him to a private clinic and the doctor who checked him is the only epileptologist in our country.
He conducted 2 EEGs. The one awake was normal. The one conducted at sleep showed right side focal epileptiform discharges with secondary generalization. He then did an MRI which came out normal. No abnormalities or damaged cells showed in the MRI image.
The doctor prescribed Tegretol (100 mg per day) which showed side effects after the first and second dosage-the symptoms were that the patient (6.5 years old) could not walk due to muscle cramps in the back of the lower part of the leg (under the knee).
The third day we did not give him Tegretol and he was able to walk and play as usual. In the evening the child started vomiting as he was eating dinner. We took him to the hospital and they administered IV and added Valium as a precaution medicine due to the fact that he did not take Tegretol that day and they hospitalized him. The next day they referred us to the State Clinic to consult with a neuropediatrician which we did. And this other doctor changed the prescription to Oxcarbazepine, but did not conduct any EEG since it will take another month to do one due to the fact that it’s the only EEG that the Clinic has. He only looked at what the fist doctor wrote; right side focal epileptiform discharges with secondary generalization.
Today is the second day that he has been on Oxcarbazepine (he will be on150 mg per day for a week and then 300 mg per day-twice per 150 MG-body weight is around 50 lbs). He is showing no signs of side effects so far.
The University Clinic Doctor did not discuss anything with us as parents except the dosage due to his loaded schedule in the hospital.
Can you please advise if the findings of the first doctor could be Benign Partial Epilepsy of Childhood with Centrotemporal Spikes (BECTS).
I also read about the side effects of Oxcarbazepine and the main concern is that it may lower the sodium levels in the blood which in turn can cause seizures. Since the doctor did not advise when to do a blood test, can you please advise when should we do the test and what is the best rout to take in case the sodium levels are lowered.
Thank you in advance,
Concerned parent
Hi dr sethi
I met an accident in 2006 with severe brain injuries. There after I started getting fits and I’m on dilatin now but I just wanted to know can this fits be cured since I’m not having it by birth tqvm
Mark
Hello Dr. Sethi, I was wondering if you could give me some insight. My husband suffered a tbi, was riding a dirtbike and hit a tree. CTs and mris normal, with exception of his nondisplaced frontal skull fracture, going into right frontal sinus. No sign of bleeding or swollen tissue surrounding fracture per CT. DOI 8/5/12. His brain injury neurologist cleared him to return to normal activities a long time ago, but warned of possibility of post traumatic epilepsy that seems to surface about 18 months after injury. It is now 18 months. He is a mechanic, working around blunt metal machines, etc, and loves going on road trips. I told him he cannot go on road trips alone, out of fear of having a seizure when driving. Am I being ridiculous? Are there other precautions we can take? if we set these precautions, how long until he is “in the clear”, ok to drive alone without having a seizure? I would ask his Dr. but she has since closed her practice. Please, any advice you can give is welcome.