EPILEPSY  [ back to Glossary Index ]
Epilepsy is a neurologic disorder involving a tendency to suffer recurrently from convulsive seizures caused by abnormal electric discharges in the brain, which has been likened to storms in the brain. The brain of an epileptic patient can be mapped to isolate the cell clusters which originate the abnormal or paroxysmal discharges, which are called the epileptiform foci. Depending on severity, seizures can cause hand tremor, lip smacking, brief blackouts, significant periods of lost consciousness, spasmodic jerks of the head or limbs or full body seizures with dramatically violent muscular contractions. Grand mal seizures (the most extreme form) involve abnormal discharges all over the brain with whole body seizure. Partial seizures involve only a part of the brain. People with temporal lobe epilepsy (TLE) often suffer from what is called complex, partial seizure disorder. A patient with TLE may suddenly hear or smell something odd that does not come from the surrounding environment, and then appear absent or vacant for a couple of minutes, and do this repeatedly during the day. In ancient Greece epilepsy was called the "sacred disease," because it appeared to observers that persons in seizure were possessed by spirits.  It is believed that epilepsy has a genetic component and an environmental component. Medical literature establishes that anoxia (during birth or any other time in life), stroke or TBI can precipitate epilepsy in a susceptible person. Julius Caesar developed epilepsy and neurologists believe this was triggered by oxygen deprivation to his brain during his difficult, protracted delivery , which resulted in the world's first caesarian birth by surgical intervention.

The overall incidence of epilepsy in TBI patients (including closed head, mild TBI without hospitalization) is just 2%-5%. For hospitalized patients with moderate to severe TBI the incidence goes up to at least 15%-20%. The incidence goes still higher for patients with a skull penetrating missile injury to the brain, for whom it is about 50%. The key risk factors for PTE (post-traumatic epilepsy) in patients who have suffered a TBI are: significant period of loss of consciousness, depressed skull fracture, subdural hematoma, craniotomy to remove a hematoma, abnormal reflexes and early seizure (i.e. seizures appearing within the first week of injury). Bleeding at the time of the TBI makes PTE more likely because the iron in hemoglobin (known as hemosiderin) is toxic to brain cells and can triggers paroxysmal electric discharges.  The Oct. 1999 issue of Headache reported on cases of severe, recurrent migraine with siderosis (deposition of hemosiderin particles along the meninges, cranial nerves or spinal cord from chronic, slow leakage of blood from aneuryism, AVM or tumor). In some of those cases protracted bouts of migraine (set off by the hemosiderin) led directly to epileptic seizures. Concussions with minimal loss of consciousness and no early seizure activity can sometimes trigger late onset of what are called complex, partial seizures. If they are going to show up they usually do so by the end of the second year following injury. If the patient has been seizure free for 5 years following injury, he is considered out of woods and no longer having any increased risk of seizures above the general population.

For TBI patients at risk of epilepsy it is best to abstain from alcohol consumption, contact sports and other known triggers for seizure disorder in a disposed patient for at least 2 years. Anti-convulsant medications like Dilantin and Tegretol have powerful adverse side effects. During the 1950s and 1960s anti-convlusants were given routinely on a long term basis to patients with head injuries based on the unproven belief that they would prevent seizures from ever developing. Studies undertaken later showed that if such drugs have any protective effect against development of seizures, it would only be during the first week after the brain injury. The studies also showed that these medications work much better to suppress seizure activity in persons already diagnosed with epilepsy, for whom prevention was no longer an issue. During the 1980s and 1990s neurologists have adopted the view that drugs like Dilantin should not be given for prophylatic reasons to all patients, and if used for that purpose then only for persons at very high risk during the first week or so.

Epilepsy comes in many forms (including complex, partial seizure disorders) and is hard to diagnose. Epileptics tend to have normal IQ, negative CT scans and frequently negative EEGs. In fact, EEGs done soon after a TBI have been shown to be poor predictors of who will develop epilepsy. The diagnosis is made on the basis of clinical history. Sometimes it requires observing the patient sleeping in a sleep lab to see the epilepsy. Video clips of "normal people" boxing, bicycling or howling in their sleep in sleep labs offer dramatic proof. Sudden episodes of staring blankly into space may indicate epilepsy. Where there is any suspicion of this disorder, a referral to an epileptologist (a neurologist specializing in epilepsy) should be made. When they make use of an EEG, they generally order a sleep-deprived EEG, because epileptiform wave activity is easier to see in the brain of a tired patient who has fallen asleep.

Epilepsy can often be held in check with anti-convulsants like Dilantin, Tegretol, Neurontin, Gabapentin and Depakote. Some epilepsy medications are toxic. In Dec. 1999, it was reported that vigabatrin was associated with bilateral visual field defects, with men twice as likely to get them than women. Use of anti-epileptics must be very carefully monitored by your physician for side effects. When seizures intensify in frequency or duration despite medication, a neurosurgical consult is usually held for consideration of surgical removal of the focus of the seizure activity in the brain. The worst form of epilepsy is status epilepticus, an unrelenting wave of one powerful seizure after another. Fortunately for TBI patients if they are going to develop epilepsy it is almost always the complex, partial form rather than status epilepticus. When epilepsy is focused in the temporal lobe the patient may experience unusual, even mystic experiences involving bright lights and spiritual or religious visions. History has many examples of famous epileptics including Fyodor Doestoevsky, the great 19th century Russian novelist. Epilepsy is a chronic disorder, which tends to grow progressively worse if not treated.  See our Links Page for consumer organizations concerned with this condition. Persons residing in Northern California may wish to contact the Stanford Comprehensive Epilepsy Center at http://www.stanford.edu/group/neurology/.