The high risk of epilepsy after brain injury lasts more than a decade after the injury took place. Thus there could be a window to prevent epilepsy occurring in these patients. These are the conclusions of an Article published Online First and in an upcoming edition of The Lancet, written by Dr Jakob Christensen, Department of Neurology, Aarhus University Hospital, Denmark, and colleagues.
The authors identified around 1.6 million young people born in Denmark from 1977-2002 from the Civil Registration System. They then obtained information on traumatic brain injury and epilepsy from the National Hospital Register and estimated relative risks.
They found that risk of epilepsy more than doubled for mild brain injury or skull fracture, and was seven times more likely in patients with serious brain injury. Even over ten years after the injury, the risk persisted—those with mild brain injury had a one-and-a-half times higher risk of epilepsy, while skull fractures doubled the risk and severe brain injury increased the risk of epilepsy by four-and-a-half times. The risk was even more pronounced in people aged over 15 years – with mild injury, increasing risk of epilepsy by three-and-a-half times, and severe injury by more than 12 times. Women also had a slightly higher risk than men. Patients with a family history were at an even more pronounced risk (almost six times the risk for mild injury and 10 times for severe injury).
The authors conclude: "Traumatic brain injury is a significant risk indicator for epilepsy many years after the injury. Drug treatment after brain injury with the aim of preventing post-traumatic epilepsy has been discouraging, but our data suggest a long time interval for potential, preventive treatment of high risk patients."
In an accompanying Comment, Professor Simon Shorvon and Dr Aidan Neligan, University College London Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK, discuss the finding that the risk of epilepsy is increased for at least 10 years after head injury and the possibility that treatment interventions to prevent the development of epilepsy might be possible.
Dr Jakob Christensen, Department of Neurology, Aarhus University Hospital, Denmark. T) +45 894 933 33 or +45 608 658 99 (mobile) E) jakob@farm.au.dk
Professor Simon Shorvon and Dr Aidan Neligan, University College London Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK. E) s.shorvon@ion.ucl.ac.uk
For full Article and Comment see: http://press.thelancet.com/epilepsy.pdf
Journal
The Lancet