A review of seizures and epilepsy following traumatic brain injury
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NEUROLOGICAL UPDATE
A review of seizures and epilepsy following traumatic brain injury Surina Fordington1 · Mark Manford2 Received: 21 April 2020 / Accepted: 14 May 2020 © The Author(s) 2020
Abstract Traumatic brain injury (TBI) is one of the commonest presentations to emergency departments and is associated with seizures carrying different significance at different stages following injury. We describe the epidemiology of early and late seizures following TBI, the significance of intracranial haemorrhage of different types in the risk of later epilepsy and the gaps in current understanding of risk factors contributing to the risk of post-traumatic epilepsy (PTE). The delay from injury to epilepsy presents an opportunity to understand the mechanisms underlying changes in the brain and how they may reveal potential targets for anti-epileptogenic therapy. We review existing treatments, both medical and surgical and conclude that current research is not tailored to differentiate between PTE and other forms of focal epilepsy. Finally, we review the increasing understanding of the frequency and significance of dissociative seizures following mild TBI. Keywords Epilepsy · Traumatic brain injury · Dissociative seizures
Introduction Seizures were first described in relation to a “gaping wound of the head” in the Edwin Smith papyrus from Babylon, dated circa 1700 BC [1]. The Hippocratic physicians later recognised post-traumatic convulsions and their lateralisation opposite to the side of injury [2]. Through much of the next 2000 years, Galen’s philosophy of humours merged with spiritual explanations of epilepsy and it was not until the nineteenth century that understanding advanced to form the basis of current knowledge. In the UK, Gowers recognised the frequency of PTE and its male preponderance [3], which was followed shortly first epilepsy surgery of the modern era, conducted on a patient with PTE [4]. Holmes identified epilepsy as a cortical disease and used his extensive experience of traumatic brain injuries from WWI to describe a range of seizure types arising from injuries to different cortical regions [5]. Epilepsy surgery over the next decades was dominated by the Montreal Group who described the macroscopic and microscopic appearance of traumatic lesions associated with epilepsy in both humans * Mark Manford [email protected] 1
University of Cambridge, Cambridge, UK
Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
2
and animals [6]. The extent of the risk was highlighted by Jennett [7] who set the investigative parameters for epidemiological studies which later investigators have followed in systematic attempts to delineate the risk factors for PTE [8, 9], but significant holes remain in our understanding. The better stratification of risk could potentially allow targeted treatment as epilepsy management starts to include treatments which may be anti-epileptogenic as well as antiseizure. To date, the treatment of PTE has not been sufficiently separated from other for
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