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A Collection of Medical & Legal Information About Brain Injury

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10 Things You Should Know About Post Traumatic Seizures ("PTS") (Epilepsy)

A person can suffer a seizure immediately after a head injury, but this is not considered PTS. Seizure onsets can occur within weeks (early seizure) or months, even up to ten years after the TBI/brain injury (late seizures). PTS can occur following all types of brain injury be it mild, moderate or severe. PTS is more likely in cases of penetrating injury to the brain, a depressed skull fracture or injury to the temporal lobe of the brain. While it was earlier thought that mild brain injury (TBI) could not give rise to PTS, studies on returning soldiers have shown otherwise. EEG - EEG (electroencephalogram) is a well-accepted test that involves the placement of electrodes on different areas of the scalp. These electrodes pick up the faint electrical impulses given off by the brain as it functions. What doctors are looking at after traumatic brain injury would be either a slowing of the waves or spike waves. A slowing indicates some ongoing brain abnormality and spikes are consistent with seizure activity. A standard EEG takes between twenty and thirty minutes. Certainly not all EEGs will capture seizure activity, even in a known epileptic. Another form of an EEG, which is called a "home EEG" or "holter EEG," is one that is attached to the patient for a period of 24 to 72 hours and is done outside of the hospital. A third type of EEG is done in the hospital and is associated with video of the patient. If the patient, for example, has a "seizure" which is seen on the video, and the EEG is normal, then the diagnosis would be a pseudo seizure, covered below. The sensitivity of spiked EEG for seizure activity is high approximately 97%. However, if someone has repeated mildly abnormal EEGs overtime which does not change following an injury, it could be a preexisting abnormality.
A "pseudo seizure" or non-epileptic seizure (NES) is a mysterious diagnosis. In its true form these individuals truly believe they are having classic seizures but they have normal EEGs. This type of psychological, but remember also biological, issue can be serious and life altering in and of itself. Many true epileptics also have non epileptic seizures as well, so it is a complex determination and field.
QEEG - a QEEG is simply a computerized EEG that takes the results of a common EEG and pairs them to "normative data" taken from a large group of normal individuals for comparison. The QEEG is held in some suspicion by the insurance industry, so if possible the test should not stand alone, although it is accurate. Medications - in any individual who is suspected of having or likely having seizure activity will be given anti-seizure medication. This can be done on a "prophylactic" bases which is to protect someone, who is not currently having seizures, from having seizures in the near future and then there would be the standard medication for the person suffering from active epilepsy. Fortunately, there are a great number of anti-seizure medications on the market. Most patients will have to try different medications to see which one agrees with them, as some reactions are unfavorable. The good news is that they all work very well. Most individuals can be almost seizure free or close to it on such medications. However, PTS is one of the most difficult types of epilepsy to get under control. Such individuals may continue to have seizures although they are on anti-seizure medication and will have to remain on it for the rest of their lives. Others may not. Types of seizures:
  • Clonic-tonic (general seizure) - this is the classic image of a seizure that is in everyone's mind, with the lack of consciousness, being on the ground, with body movements arising from abnormal activity in both sides of the brain. It is what's also known as a grand mal seizure.
  • Focal onset seizures - this used to be called a partial seizure, one which occurs from cells on one side of the brain or the other, not both. Subdivisions within this type of seizure include:
    • Focal onset aware seizures (simple partial seizures) - the person remains alert and able to interact, the seizures are brief lasting seconds to less than two minutes.
    • Focal onset impaired awareness: this used to be called the "complex partial seizure" and it is a person who is confused or unaware during a seizure on one side of the brain.
    • A seizure can be a "motor seizure" which includes rhythm jerking movements, muscle weakness, or rigidity or twitching. A "non motor" seizure is called an absence seizure which can be manifested by staring spells and twitching, with or without awareness.
Outcomes - a diagnosis of post traumatic epilepsy is a serious and lifelong disability. In addition to not being able to drive, these individuals have a very high annual costs of health care because of falling, accidents, and injuries. Continued refractory seizure activity is also damaging to cognitive capability of the person and such limitations can worsen with additional seizures. It is difficult, of course, to keep a job, a marriage or other important aspects of life because when epilepsy is present any type of PTS is extraordinarily serious and should be compensated as such. Again, if confusing spells or falling occurs post traumatic brain injury (TBI), try to FILM IT. A proper diagnosis and your ability to show seizures are aided by videos.

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