Evaluation of seizure-like episodes in survivors of moderate and severe traumatic brain injury

Anne M. Hudak, Kavita Trivedi, Caryn R. Harper, Kimberly Booker, Rajani R. Caesar, Mark Agostini, Paul C. Van Ness, Ramon Diaz-Arrastia

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background: Transient paroxysmal alterations of consciousness or behavior are common sequelae of moderate and severe traumatic brain injury (TBI). Clinicians caring for patients with such episodes often diagnose them as epileptic seizures, a frequent and well-studied complication of TBI. As it is difficult to confirm this diagnosis, antiepileptic drugs are often used empirically. However, as such therapy is frequently ineffective, we studied the usefulness of prolonged video electroencephalogram (VEEG) monitoring in the clinical management of paroxysmal behaviors in TBI survivors. Methods: Records of patients referred evaluation in an epilepsy monitoring unit for management of medically intractable epilepsy were retrospectively reviewed. Patients with a documented history of moderate-to-severe brain injury preceding the onset of epilepsy were identified. These patients were studied by simultaneous videotape and scalp electroencephalographic recordings, and the majority also underwent magnetic resonance imaging and neuropsychologic studies. Results: Of the 1858 consecutive admissions over a 66-month period, 127 (7%) fulfilled enrollment criteria. VEEG monitoring was conducted for an average of 4.6 days. Monitoring was successful in establishing a diagnosis in 82% of the cases referred: 62% had focal seizures, 6% had generalized seizures, and 33% had psychogenic nonepileptic seizures. Of those with temporal lobe epilepsy, 53% had mesial temporal sclerosis, as shown by magnetic resonance imaging. Conclusions: VEEG is a useful procedure in the evaluation of TBI survivors with spells. The yield of diagnoses that may alter treatment is substantial. Additionally, mesial temporal sclerosis is associated with TBI. Given the variety of seizure types found in survivors of moderate-to-severe TBI, obtaining specific diagnosis of seizure type by VEEG monitoring impacts treatment options.

Original languageEnglish (US)
Pages (from-to)290-295
Number of pages6
JournalJournal of Head Trauma Rehabilitation
Volume19
Issue number4
StatePublished - Jul 2004

Fingerprint

Survivors
Seizures
Electroencephalography
Epilepsy
Sclerosis
Magnetic Resonance Imaging
Videotape Recording
Temporal Lobe Epilepsy
Scalp
Consciousness
Anticonvulsants
Brain Injuries
Traumatic Brain Injury
Therapeutics

Keywords

  • Nonepileptic seizures
  • Posttraumatic epilepsy
  • Video-EEG monitoring

ASJC Scopus subject areas

  • Rehabilitation
  • Clinical Neurology
  • Health Professions(all)

Cite this

Hudak, A. M., Trivedi, K., Harper, C. R., Booker, K., Caesar, R. R., Agostini, M., ... Diaz-Arrastia, R. (2004). Evaluation of seizure-like episodes in survivors of moderate and severe traumatic brain injury. Journal of Head Trauma Rehabilitation, 19(4), 290-295.

Evaluation of seizure-like episodes in survivors of moderate and severe traumatic brain injury. / Hudak, Anne M.; Trivedi, Kavita; Harper, Caryn R.; Booker, Kimberly; Caesar, Rajani R.; Agostini, Mark; Van Ness, Paul C.; Diaz-Arrastia, Ramon.

In: Journal of Head Trauma Rehabilitation, Vol. 19, No. 4, 07.2004, p. 290-295.

Research output: Contribution to journalArticle

Hudak, AM, Trivedi, K, Harper, CR, Booker, K, Caesar, RR, Agostini, M, Van Ness, PC & Diaz-Arrastia, R 2004, 'Evaluation of seizure-like episodes in survivors of moderate and severe traumatic brain injury', Journal of Head Trauma Rehabilitation, vol. 19, no. 4, pp. 290-295.
Hudak, Anne M. ; Trivedi, Kavita ; Harper, Caryn R. ; Booker, Kimberly ; Caesar, Rajani R. ; Agostini, Mark ; Van Ness, Paul C. ; Diaz-Arrastia, Ramon. / Evaluation of seizure-like episodes in survivors of moderate and severe traumatic brain injury. In: Journal of Head Trauma Rehabilitation. 2004 ; Vol. 19, No. 4. pp. 290-295.
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