Veterans with epilepsy after TBI may have higher mortality rates

Military veterans who develop epilepsy after a traumatic brain injury may face a higher risk of death than those with epilepsy but no history of brain injury.

The study analysed 210,182 veterans with epilepsy, including 28,832 who had sustained a traumatic brain injury (TBI) within five years before diagnosis.

Researchers from Baylor College of Medicine reviewed data from the Veterans Health Administration, following participants for an average of six years.

During that time, 10,780 veterans with post-traumatic epilepsy died, compared with 92,621 veterans who had epilepsy without a prior brain injury.

After adjusting for other factors, those with post-traumatic epilepsy were found to be 2 per cent more likely to die during the study period.

Study author Dr Zulfi Haneef said: “While these findings need to be validated in future studies, we recommend that people who develop epilepsy after a traumatic brain injury are closely monitored and, especially if seizures do not respond well to treatment, are prioritised for surgery or a change in medication without delay.”

The risk of death varied depending on the nature of the injury.

Veterans with skull or facial fractures had an 18 per cent higher risk of death, those with diffuse injury — widespread brain damage — had a 17 per cent higher risk, and those with localised injury had a 16 per cent higher risk.

In contrast, veterans whose TBI was caused by concussion had lower mortality rates than those with epilepsy but no brain injury.

The researchers also found that veterans aged 18–39 who developed epilepsy after an extracerebral TBI — an injury affecting tissue outside the brain — were twice as likely to die during the study as people of the same age with epilepsy but no brain injury.

Several factors could explain why concussion-related epilepsy appeared to carry a lower mortality risk, Haneef said.

Some causes of non-traumatic epilepsy, such as stroke, infections or tumours, have higher mortality rates in themselves.

“It’s also possible that when people develop epilepsy after a traumatic brain injury, they receive earlier treatment and may have better access to care and improved outcomes compared with those who have not had a brain injury,” he said.

On average, participants with post-traumatic epilepsy were 53 years old at diagnosis, while those without a previous brain injury were 61.

One limitation of the study was that information on TBIs occurring before veterans entered the Veterans Health Administration system was limited.

The research was funded by the US Department of Defense.