Seizures

There is a common association between Traumatic Brain Injury (TBI) and seizures. Seizures can occur soon after a head injury or months (or even years later). If a patient has more than one seizure, the condition is labeled post-traumatic epilepsy and it carries a worse prognosis.

What exactly is a seizure? The public is aware of generalized seizures when the body shakes controllably, patients lose awareness, and often bite their tongue. However, seizure activity can be much more subtle and a detailed history must often be taken to differentiate seizures from other medical findings. The more severe the head trauma, the more common the seizure.

The seizure is caused be an abnormal discharge of electrical activity in the brain. This is most often caused by a structural change in brain tissue that has occurred from trauma. Unfortunately, seizure activity can make TBI worse by depriving the brain of oxygen or releasing chemical triggers of inflammation- the seizure itself can act like a second brain injury. Seizures are aggressively treated with a variety of medications and treatment is usually successful.

There are certainly other causes of seizure activity including altered metabolic states of the body resulting in abnormal blood test values. Other structural abnormalities of the brain can cause seizures. Sometimes the ultimate cause can never be determined. Head injury is a common cause of seizures and the history of head injury must be considered in any patient presenting with a seizure of unclear etiology. An EEG (an electroencephalogram), which is a relatively simple test of brain electrical activity, is important and is generally performed by a neurologist. MRI scans (as discussed in previous blogs) are also critical. The EEG is often used in evaluating TBI subjects even with no seizure activity (this could be the subject of an entire separate blog and analysis).

Seizure activity has obvious importance and real life consequences. In many states, patients being diagnosed with epilepsy prevents a person from obtaining a driver’s license and precludes employment in a variety of jobs.

As I am an ophthalmologist, seizure activity can be accompanied by a variety of visual symptoms. Patients often see unusual visual patterns with zig-zagging and colored lights just before or during a seizure. These symptoms generally occur in both eyes simultaneously and can be quite disturbing. These symptoms can be similar to a migraine aura (symptoms that proceed a migraine headache). Migraine headaches can also be caused by head trauma and it is important to distinguish a migraine aura from mild seizure activity.

In mild TBI, seizures are less common, but if a seizure occurs in the emergency room, or when the patient gets home, it is a warning sign that important findings may have been missed. Epilepsy, even if treated, can be a serious long-term impairment for patients with TBI. The drugs used to reduce seizure activity often have numerous side effects and affect a head injury patient for the remainder of his/her life.

Steven H. Rauchman, M.D. is an eye physician and surgeon who has been in private practice for 30 years. He has served as a Traumatic Brain Injury (TBI) medical/legal expert for the last 6 years specializing in the area of personal injury and related traumatic brain injuries.

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