Posttraumatic Epilepsy Workup
- Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD more...
In a patient who is still hospitalized after a recent head injury, investigation of a seizure should focus on determining whether an intracranial bleed or a change in clinical condition (eg, hyponatremia) has caused the seizure. If the patient is otherwise in stable condition, the serum electrolytes are within the normal range, and the neurologic findings are the same as those before the seizure, further laboratory studies are not needed.
In a patient presenting some time after the injury, the usual investigations applicable for the first epileptic seizure should be performed. See First Pediatric Seizure and First Adult Seizure for more discussion of these topics. It often includes and EEG and neuroimaging.
Serum prolactin measurement can be measured after the seizure to help differentiate pseudoseizures from seizures. However, this is still more of a research point rather than a well-recognized standard test.
Brain magnetic resonance imaging (MRI) is the study of choice, and many clinicians perform it in all patients with posttraumatic seizures. If MRI is not readily available, head computed tomography (CT) can be substituted. CT is less sensitive than MRI, but should be able to depict all pathology (eg, intracranial bleed) that needs urgent intervention.
Electroencephalography (EEG) is useful mainly for localizing seizure foci and for prognosticating their severity. EEG is not helpful in predicting the likelihood of posttraumatic seizure in a given patient. However, it may be helpful in predicting relapse before anticonvulsant medication is withdrawn.
Video-EEG monitoring may be helpful in differentiating between pseudoseizures and posttraumatic epilepsy seizures. The video-EEG monitoring should be performed on those who are medically refractory to pursue epilepsy resective surgery or neurostimulation.
Frey LC. Epidemiology of posttraumatic epilepsy: a critical review. Epilepsia. 2003. 44 Suppl 10:11-7. [Medline].
D'Ambrosio R, Perucca E. Epilepsy after head injury. Curr Opin Neurol. 2004 Dec. 17(6):731-5. [Medline].
Diaz-Arrastia R, Gong Y, Fair S, Scott KD, Garcia MC, Carlile MC, et al. Increased risk of late posttraumatic seizures associated with inheritance of APOE epsilon4 allele. Arch Neurol. 2003 Jun. 60(6):818-22. [Medline].
Anderson GD, Temkin NR, Dikmen SS, Diaz-Arrastia R, Machamer JE, Farhrenbruch C. Haptoglobin phenotype and apolipoprotein E polymorphism: relationship to posttraumatic seizures and neuropsychological functioning after traumatic brain injury. Epilepsy Behav. 2009 Nov. 16(3):501-6. [Medline].
Chamelian L, Reis M, Feinstein A. Six-month recovery from mild to moderate Traumatic Brain Injury: the role of APOE-epsilon4 allele. Brain. 2004 Dec. 127:2621-8. [Medline].
Annegers JF, Hauser WA, Coan SP, et al. A population-based study of seizures after traumatic brain injuries. N Engl J Med. 1998 Jan 1. 338(1):20-4. [Medline].
Angeleri F, Majkowski J, Cacchio G, et al. Posttraumatic epilepsy risk factors: one-year prospective study after head injury. Epilepsia. 1999 Sep. 40(9):1222-30. [Medline].
Raymont V, Salazar AM, Lipsky R, Goldman D, Tasick G, Grafman J. Correlates of posttraumatic epilepsy 35 years following combat brain injury. Neurology. 2010 Jul 20. 75(3):224-9. [Medline]. [Full Text].
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. 2008 Jul. 22(7):653-62. [Medline].
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. 2004 Jul-Aug. 19(4):290-5. [Medline].
Temkin NR, Dikmen SS, Wilensky AJ. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med. 1990 Aug 23. 323(8):497-502. [Medline].
Löscher W, Brandt C. Prevention or modification of epileptogenesis after brain insults: experimental approaches and translational research. Pharmacol Rev. 2010 Dec. 62(4):668-700. [Medline]. [Full Text].
Pearl PL, McCarter R, McGavin CL, Yu Y, Sandoval F, Trzcinski S, et al. Results of phase II levetiracetam trial following acute head injury in children at risk for posttraumatic epilepsy. Epilepsia. 2013 Jul 22. [Medline].
[Guideline] 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. 2003 Jan 14. 60(1):10-6. [Medline].
Beghi E. Overview of studies to prevent posttraumatic epilepsy. Epilepsia. 2003. 44 Suppl 10:21-6. [Medline].
Schierhout G, Roberts I. Anti-epileptic drugs for preventing seizures following acute traumatic brain injury. Cochrane Database Syst Rev. 2001. CD000173. [Medline].
Szaflarski JP, Sangha KS, Lindsell CJ, Shutter LA. Prospective, randomized, single-blinded comparative trial of intravenous levetiracetam versus phenytoin for seizure prophylaxis. Neurocrit Care. 2010 Apr. 12(2):165-72. [Medline].
Temkin NR. Prophylactic Anticonvulsants After Neurosurgery. Epilepsy Curr. 2002 Jul. 2(4):105-107. [Medline].
Milligan TA, Hurwitz S, Bromfield EB. Efficacy and tolerability of levetiracetam versus phenytoin after supratentorial neurosurgery. Neurology. 2008 Aug 26. 71(9):665-9. [Medline].
Temkin NR, Dikmen SS, Anderson GD, et al. Valproate therapy for prevention of posttraumatic seizures: a randomized trial. J Neurosurg. 1999 Oct. 91(4):593-600. [Medline].
Mori A, Yokoi I, Noda Y, Willmore LJ. Natural antioxidants may prevent posttraumatic epilepsy: a proposal based on experimental animal studies. Acta Med Okayama. 2004 Jun. 58(3):111-8. [Medline].