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MILITARY
MEDICINE
Epilepsy and traumatic brain injury
By Mary Jo Pugh, Ph.D.
Epilepsy is a chronic disorder, the hallmark of which is recurrent, nitive impairments (i.e., memory, concentration) as a major com-
unprovoked seizures. Epilepsy affects one in 26 Americans and is a plaint, which is a particular concern in the post-9/11 cohort,
potential result of traumatic brain injury (TBI). This is a significant where cognitive problems are already well described. Other diffi-
concern for the Department of Defense (DoD) and Department of culties among people with epilepsy include lifestyle change (e.g.
Veterans Affairs (VA) given that approximately 20 percent of more inability to drive, change in activity levels) and loss of confidence
than 1.2 million service members have suffered a TBI while de- about their own abilities. Studies of the impact of epilepsy in vet-
ployed in support of the wars in Iraq and Afghanistan (post-9/11). erans with epilepsy conducted by our team suggest that the im-
TBI severity can range from mild (e.g. concussion) to severe and/or pact of epilepsy on patients is likely broad, and significantly
penetrating, although approximately 80 percent of head injuries are affects community integration and participation.
considered to be mild (mTBI). The Office of the Army Surgeon
General identified approximately 300,000 documented incidents of Epilepsy also has significant costs to the patient and the health
TBI among deployed and non-deployed service member between care system. Studies have estimated that the annual cost of
September 2001 and June 2015. epilepsy care in the U.S. was $12.5 billion in 2000, and that in-
direct costs (e.g. caretaker time away from work) comprise 67 per-
Studies of veterans from World War II, the Korean War and cent of the cost of epilepsy. Given the relatively young age of
Vietnam have found that individuals with combat-related pene- post-9/11 veterans, these costs of care, both personal and finan-
trating TBI were more likely to later experience epilepsy (or post- cial, may profoundly affect the lives of those veterans, their fam-
traumatic epilepsy) for up to 40 years following injury. However, ilies, and the health care systems on which they depend for care.
these studies did not explore the development of posttraumatic Better understanding these burdens was identified as a high pri-
epilepsy among those with mTBI — one of the signature injuries ority of Congress to ensure that DoD and VA are equipped to
of post-9/11 wars. Because the majority of head injuries are mild, provide superior health care that maximizes the quality of life for
even a slightly elevated risk of posttraumatic epilepsy following all military personnel and veterans with epilepsy.
mTBI could substantially increase the burden of epilepsy on pa-
tients and families and increase the care burden for epilepsy on Study reveals insights
the DoD and VA health care systems. My colleagues and I are Our team has designed a comprehensive study to examine the
conducting a longitudinal study to describe the impact of mTBI
on epilepsy, and the burden of epilepsy on the veteran, the family association between mTBI and epilepsy using data from the DoD,
and the health care system. the VA, and participant self-report. This multifaceted approach
will allow the team to not only examine the emergence of epilepsy
Burdens of epilepsy among individuals with mTBI, but it will also provide insight on
Existing studies reveal that people with epilepsy identify cog- how blast-related TBI may differ from non-blast TBI, and how
deployment related mTBI is associated with epilepsy in the con-
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