Posttraumatic Epilepsy Associated with Poor Outcomes 12 Months After Injury

October 2022

Posttraumatic epilepsy (PTE) may develop after traumatic brain injury (TBI), but information about the association of PTE with cognitive and functional outcomes is lacking. The Transforming Research and Clinical Knowledge in Traumatic Brain Injury study is a prospective registry of patients with TBI and controls. Investigators conducted a prospective cohort study using the registry database to determine the incidence and outcomes of PTE.

To determine the incidence of PTE, the investigators used the National Institute of Neurological Disorders and Stroke Epilepsy Screening Questionnaire to identify patients with a self-reported diagnosis of PTE. This group had seizures beginning >7 days after the TBI and were told by a healthcare provider that they had epilepsy or seizures after the TBI.

The primary outcomes were the rate of PTE and scores on symptom and functional tests taken at 6 and 12 months after injury. Controls were orthopedic trauma participants who had injuries to other regions of the body and uninjured participants.

A total of 1885 participants, including 1493 with TBI, were included in the study. The mean age was 41.3 years and 66% were men. The incidence of self-reported diagnosis of PTE was 2.7% for participants with TBI. A diagnosis of epilepsy was not reported in any participant with other orthopedic injuries or uninjured controls.

The severity of the initial injury was positively associated with the risk of PTE. Glasgow Coma Scale scores at the time of injury were significantly worse in patients with self-reported PTE compared with patients with TBI without PTE (P <.001). In addition, >12% of participants with severe TBI based on the Glasgow Coma Scale score self-reported a diagnosis of PTE compared with 0.9% of those with mild TBI. The risk ratios for PTE were highest for participants with subdural hematoma, epidural hematoma, intraventricular hemorrhage, subarachnoid hemorrhage, or contusion.

The investigators also found that cognitive and functional outcomes were worse at 12 months after injury for participants with TBI who reported PTE compared with participants with TBI who did not report PTE. Patients with PTE had significantly worse scores on the Glasgow Outcome Scale Extended-TBI for function, the Rivermead Cognitive Metric for cognition, and the Brief Symptom Inventory-18 for mood, even after adjusting for age and severity of the initial injury.

The investigators noted that the use of a survey for self-reported PTE rather than clinical records was a limitation of the study. In addition, the Neurological Disorders and Stroke Epilepsy Screening Questionnaire has not been validated for detecting PTE. However, the investigators pointed out that the incidence of PTE in their study is similar to that of previously published studies and there were no cases of PTE in controls. These observations suggested that the questionnaire was likely to accurately identify cases of PTE. Other limitations were that they did not consider the severity of epilepsy and the effectiveness of treatment.

The investigators were unable to draw conclusions about a mechanism behind the development of PTE and poor functional outcomes. They wrote, “it is unclear if patients with underlying cognitive risk factors or predispositions for epilepsy have a greater propensity to develop PTE after TBI or if developing PTE after TBI leads to decreased cognitive outcomes.”

The investigators concluded that “because PTE is associated with unfavorable outcomes, clinicians should have a high degree of suspicion for PTE after TBI and consider antiepileptogenic therapies as needed.”


Burke J, Gugger J, Ding K, et al. Association of posttraumatic epilepsy with 1-year outcomes after traumatic brain injury. JAMA Netw Open. 2021;4(12):e2140191.

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