Post-traumatic seizure

Post-traumatic seizures (posttraumatic seizures) are caused by brain damage following a physical trauma. Those who experience a traumatic brain injury are at risk of post-traumatic epilepsy (PTE). The terms, post-traumatic seizure and post-traumatic epilepsy are sometimes used interchangeably in medical material, but people with post-traumatic seizure do not necessarily develop epilepsy which is a neurological disorder of malfunctioning brain cells that results in chronic seizures. 

Definition & Facts

Post-traumatic seizures result from a sudden burst of electrical activity or nerve impulses within the brain. Different physical responses may manifest when an individual is experiencing this burst of abnormal electrical activity known as a seizure. 

There are two types of seizures: general and partial (also known as focal or localized seizures). General seizures affect the entire brain while partial seizures only affect a portion of the brain. Different types of partial seizures include the following:

• Simple motor
• Simple sensory
• Simple autonomic
• Simple psychic
• Complex impairment
• Partial with generalization 

Post-traumatic seizures may indicate that a serious traumatic brain injury (TBI) has occurred, and the sudden electrical impulse experienced during a post-traumatic seizure may further damage the already injured brain. 

Immediate, early, and late seizures are categories that describe the post-traumatic seizure according to the time that has elapsed between the patient's injury and the onset of the seizure. Immediate post-traumatic seizure is characterized by seizures that occur within 24 hours of the injury; early seizures occur within week one; and late seizures occur after the first week.

Some doctors categorize late post-traumatic syndrome as post-traumatic epilepsy. Those who have early and late post-traumatic seizures are at greater risk for developing post-traumatic epilepsy.

Symptoms & Complaints

Post-traumatic general seizures may cause convulsions, loss of consciousness, repetitive or sporadic jerking, stiffness, or loss of muscle tone. A grand mal seizure may occur which is a violent and severe type of seizure.

Physical pain and complications can result from tongue-biting, falling or twisting. The already traumatized brain may experience compounded trauma from internal electrical impulses and from possibly hitting the head again during a seizure. 

Post-traumatic partial seizures may create silent staring, jerking movements, rigidity, memory loss, emotional responses, lip movements, chewing, involuntary coordinated movements that could include walking, and unusual sensory symptoms that affect vision, hearing, taste, or touch.

Further complications may occur when multiple seizures are experienced following a traumatic brain injury. During a seizure the brain’s oxygen is often reduced (hypoxia) which can result in an increase in intracranial pressure. 

Causes

A post-traumatic seizure is experienced in five to seven percent of people after a traumatic brain injury. The risk of seizures is increased when the traumatic brain injury is severe. The risk of post-traumatic seizure diminishes as time passes following the injury, but the risk may remain a possibility for more than 15 years after the initial injury or incident.

Head trauma victims are more likely to experience post-traumatic seizure if they abuse alcohol or if a bit of metal from the injury remains in their head. Penetrating head trauma victims carry the highest risk of developing post-traumatic seizure.

Children and older adults have a higher risk of post-traumatic seizure. Because men have a greater risk of traumatic brain injury, they are also at greater risk for complications of traumatic brain injury such as post-traumatic seizures. Common causes of traumatic brain injury include falls, motor vehicle accidents, combat wounds, violent acts, and sports injuries.

Diagnosis & Tests

Physical examinations will be conducted assuming the patient is stabilized from the traumatic brain injury. Neurological examinations will be taken to assess sensory and motor responses. Blood tests will be taken to measure levels of serum electrolytes as electrolyte imbalances are associated with seizures. Traumatic brain injury may not be the cause of a seizure in a number of circumstances, including when the patient has a previously diagnosed seizure disorder.

A magnetic resonance imaging (MRI) or a computed tomography (CT) scan may be used to determine if a patient is experiencing post-traumatic seizure. A positron emission tomography (PET) scan may be taken to assess brain function.  

Concussive convulsions may also occur immediately after a brain injury but are not synonymous with post-traumatic seizure. These convulsions which occur in approximately one of every 70 concussions are less severe, are not caused by structural brain injury, and do not require anticonvulsant treatment.

Treatment & Therapy

The traumatic brain injury must be stabilized before an immediate traumatic injury can be treated. Anticonvulsant drugs can be given intravenously immediately after or shortly following the injury to prevent seizures. They are not always successful in preventing all seizures and may not work at all for some people. They usually are successful in stopping seizures that are already occurring. 

Phenytoin, valproate, carbamazepine, and phenobarbital are possible drugs. Benzodiazepine is another antiepileptic drug used in the treatment of post-traumatic seizures. Topiramate and levetiracetam may also be helpful drugs.

Surgery can be performed to remove the part of the brain that is causing the seizure. The goal of epilepsy surgery is to excise abnormal tissues without impairing the functioning of the brain.

Prevention & Prophylaxis

Psychological stress may compound the effects of the traumatic brain injury, so stress reduction and relaxation techniques should be implemented. Heavy drinking can also exacerbate effects, and one should avoid alcohol while recovering from a traumatic brain injury and seek treatment if necessary via counseling, group therapy, and/or psychotherapy if necessary.

Any other instructions that are given by the medical professionals to avoid the risk of post-traumatic seizure should be heeded. A person ought to avoid sports activities if they were the cause of the traumatic brain injury.