eMedicine Specialties > Neurology > Seizures and Epilepsy

Posttraumatic Epilepsy: Follow-up

Author: Ewa Posner, MD, MRCP, Consultant Pediatrician, Department of Pediatrics, University Hospital of North Durham, UK
Coauthor(s): Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Contributor Information and Disclosures

Updated: Oct 22, 2009

Follow-up

Further Outpatient Care

Regular follow-up should be performed for a review of medications; for neuropsychological assessment; and for monitoring of adverse effects, drug levels if indicated, and the patient's neurologic status.

Inpatient & Outpatient Medications

  • Prophylaxis
    • Findings of the latest Cochrane Review are that prophylactic treatment in the acute phase does not reduce death or disability rates.
    • Treatment of early PTS does not decrease the risk of late PTS.
  • Treatment
    • Early PTS: The recommendation is that early PTS should be treated promptly, as seizure activity is likely to further damage the already-compromised brain. IV phenytoin and sodium valproate are the drugs of choice and usually effective in stopping the seizure.
    • Late PTS: Treatment is not mandatory, as some patients with a low frequency of seizures may choose not to take regular medication. Compliance with long-term treatment is often poor in this group of patients. The anticonvulsant usually prescribed is sodium valproate, phenytoin, or carbamazepine. Among the newer anticonvulsants, levetiracetam has been used successfully after craniotomy.

Deterrence/Prevention

  • A large percentage of PTEs should be viewed as preventable. Encourage preventive strategies, such as use of child seats and the use of helmets when cycling.
  • Current evidence suggests that the treatment of early PTS does not influence the incidence of PTE. Routine preventive anticonvulsants are not indicated for patients with head injuries.
  • Some have proposed the existence of a therapeutic window of opportunity of about 1 hour after traumatic brain injury. During this period, an agent (eg, sodium valproate), if delivered, may prevent or abort the epileptogenic process. Studies to explore such treatment are underway.

Complications

  • Posttraumatic status epilepticus, which is more common in children than adults, is a complication of PTE.
  • Psychological problems related to social isolation and the stigma of epilepsy are common and must be addressed.

Prognosis

  • The risk of PTS decreases with time and reaches the normal value for the population at 5 years after the head injury.
  • About half the patients who develop late PTS have 3 or fewer seizures and go into spontaneous remission thereafter.

Patient Education

  • As in any seizure disorder, patients must be warned to exercise caution during bathing, swimming, and climbing heights. They should never be alone during these activities. In all situations, appropriate steps should be taken to ensure the safety of the person if a seizure occurs.
  • Patients must also be counseled about the limitations in obtaining a driver's license.
  • For excellent patient education resources, visit eMedicine's Brain and Nervous System Center. Also, see eMedicine's patient education article Epilepsy.

Miscellaneous

Medicolegal Pitfalls

  • The medical/legal aspect is an important issue in cases of PTE, as some patients pursue legal actions against various authorities and individuals responsible for the circumstances of the accident.
  • Clinicians are often asked to estimate the risk of a patient developing PTE in the future as a result of sustained brain injury. This is a difficult task and should be left to an experienced senior specialist.

Special Concerns

  • Many patients are not able to obtain a driving license.
 


More on Posttraumatic Epilepsy

Overview: Posttraumatic Epilepsy
Differential Diagnoses & Workup: Posttraumatic Epilepsy
Treatment & Medication: Posttraumatic Epilepsy
Follow-up: Posttraumatic Epilepsy
References
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References

  1. Mori A, Yokoi I, Noda Y, Willmore LJ. Natural antioxidants may prevent posttraumatic epilepsy: a proposal based on experimental animal studies. Acta Med Okayama. Jun 2004;58(3):111-8. [Medline].

  2. Skandsen T, Ivar Lund T, Fredriksli O, Vik A. Global outcome, productivity and epilepsy 3--8 years after severe head injury. The impact of injury severity. Clin Rehabil. Jul 2008;22(7):653-62. [Medline].

  3. Hudak AM, Trivedi K, Harper CR, Booker K, Caesar RR, Agostini M, et al. Evaluation of seizure-like episodes in survivors of moderate and severe traumatic brain injury. J Head Trauma Rehabil. Jul-Aug 2004;19(4):290-5. [Medline].

  4. Temkin NR, Dikmen SS, Wilensky AJ. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med. Aug 23 1990;323(8):497-502. [Medline].

  5. Milligan TA, Hurwitz S, Bromfield EB. Efficacy and tolerability of levetiracetam versus phenytoin after supratentorial neurosurgery. Neurology. Aug 26 2008;71(9):665-9. [Medline].

  6. Angeleri F, Majkowski J, Cacchio G, et al. Posttraumatic epilepsy risk factors: one-year prospective study after head injury. Epilepsia. Sep 1999;40(9):1222-30. [Medline].

  7. Annegers JF, Hauser WA, Coan SP, et al. A population-based study of seizures after traumatic brain injuries. N Engl J Med. Jan 1 1998;338(1):20-4. [Medline].

  8. Beghi E. Overview of studies to prevent posttraumatic epilepsy. Epilepsia. 2003;44 Suppl 10:21-6. [Medline].

  9. Chang BS, Lowenstein DH. Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. Jan 14 2003;60(1):10-6. [Medline].

  10. Chang BS, Lowenstein DH. Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. Jan 14 2003;60(1):10-6. [Medline].

  11. D'Ambrosio R, Perucca E. Epilepsy after head injury. Curr Opin Neurol. Dec 2004;17(6):731-5. [Medline].

  12. Frey LC. Epidemiology of posttraumatic epilepsy: a critical review. Epilepsia. 2003;44 Suppl 10:11-7. [Medline].

  13. Garga N, Lowenstein DH. Posttraumatic epilepsy: a major problem in desperate need of major advances. Epilepsy Curr. Jan-Feb 2006;6(1):1-5. [Medline].

  14. Schierhout G, Roberts I. Anti-epileptic drugs for preventing seizures following acute traumatic brain injury. Cochrane Database Syst Rev. 2001;CD000173. [Medline].

  15. Temkin NR. Prophylactic Anticonvulsants After Neurosurgery. Epilepsy Curr. Jul 2002;2(4):105-107. [Medline].

  16. Temkin NR, Dikmen SS, Anderson GD, et al. Valproate therapy for prevention of posttraumatic seizures: a randomized trial. J Neurosurg. Oct 1999;91(4):593-600. [Medline].

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Further Reading

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Keywords

PTE, head injury, head trauma, posttraumatic seizure, PTS, traumatic brain injury, TBI

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Contributor Information and Disclosures

Author

Ewa Posner, MD, MRCP, Consultant Pediatrician, Department of Pediatrics, University Hospital of North Durham, UK
Ewa Posner, MD, MRCP is a member of the following medical societies: European Paediatric Neurology Society and Royal College of Paediatrics and Child Health
Disclosure: Nothing to disclose.

Coauthor(s)

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

Medical Editor

Joseph F Hulihan, MD, Vice President, Medical Affairs, Ortho-McNeil Janssen Scientific Affairs, LLC
Joseph F Hulihan, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Headache Society, and American Medical Association
Disclosure: Johnson & Johnson Salary Employment; Johnson & Johnson Stock Employment

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jose E Cavazos, MD, PhD, FAAN, Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, University of Texas Health Science Center at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center; Director of the Epilepsy Center, Audie L Murphy Veterans Affairs Medical Center
Jose E Cavazos, MD, PhD, FAAN is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and Society for Neuroscience
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
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