Posttraumatic Epilepsy Workup

Updated: Dec 06, 2017
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
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Workup

Approach Considerations

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.

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Neuroimaging

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.

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Electroencephalography

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 However, it may be helpful in predicting relapse before anticonvulsant medication is withdrawn.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.

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