Abstracts

Rationale: Traumatic brain injury (TBI) is the second most common cause of epilepsy in adults, responsible for 20% of symptomatic epilepsy cases and 3-6% of all new onset epilepsy cases. The Kern Medical (KM) Epilepsy Center is the first and only NAEC certified adult epilepsy center in the Central Valley between Sacramento and Los Angeles. It was established as part of the USC Epilepsy Care Consortium, a unique partnership of 10 NAEC centers in Southern California. It serves as a singular resource for epilepsy patients in this region. This study conducted a retrospective review of post-traumatic epilepsy (PTE) in underserved patients at KM to assess the correlation between the characteristics of their TBI and the type and severity of epilepsy developed.


Methods: A retrospective chart review was conducted, analyzing inpatient and outpatient clinic data at KM from 2013 to 2023 or to their most recent follow up in 2024. A cohort of 37 patients who developed seizures following a TBI at ages 2 to 77 years, was identified. Patient charts were reviewed for TBI profiles and seizure type and frequency. TBI severity was classified as mild, moderate, or severe using the Glasgow Coma Scale (GCS), and neuroimaging was utilized to qualitatively categorize TBI types, as well as to assess the localization of the injury. Seizure frequency was categorized into seizure remission (seizure-free for 5+ years), well-controlled (< 1 seizure/year), uncontrolled ( >1 seizure/year), and uncontrolled with refractory seizures ( >2 medications). Seizure types were classified by onset into the following categories: focal aware seizures, focal seizures impaired awareness (FSIA), focal to bilateral tonic-clonic (FBTC) seizures, and unknown onset seizures.

Results: Among the identified patients, 70.2% were male and 56.8% of the underserved patient population were Hispanic. Of the 13 patients with refractory epilepsy, 9 had severe TBI, most commonly subdural hemorrhage. Multilobar injuries, primarily affecting the frontal and temporal lobes, were observed in 46.1% of TBI cases correlated with refractory epilepsy. FBTC seizures occurred in 78.3% of the cohort, 13.4% developed FSIA, and the remaining patients had unknown onset seizures. Only 3 patients underwent vagus nerve stimulation (VNS) therapy, and no resective surgeries were performed. PTE developed within one year in 64.8% of patients, with 21.6% experiencing acute post-traumatic seizures within 24 hours of their injury.


Conclusions: A correlation was identified between the severity of TBI and the likelihood of developing refractory epilepsy. However, no significant correlation was found between the severity of TBI and the timing of PTE onset, nor between the severity of TBI and the small percentage of patients who achieved seizure remission. Notably, of the 8 patients who achieved seizure remission, 3 patients experienced seizure recurrence following a subsequent mild TBI. Additional work is ongoing to further characterize PTE in underserved populations outside major metropolitan areas where the majority of NAEC centers are located.


Funding: None