Higher Epilepsy Mortality Rates Associated with Previous TBI in US Veterans

In a recent study, researchers discovered evidence that a traumatic brain injury (TBI) at least 5 years before a diagnosis of epilepsy was associated with a higher rate of mortality in U.S. military veterans.

“Post-traumatic epilepsy (PTE) is presumed to have worse outcomes than other forms of epilepsy, although it has never been definitively shown that mortality is higher,” Zulfi Haneef, MD, MBBS, FRCP, professor of neurology at Baylor College of Medicine said.

The researchers sought to clarify mortality rates for PTE and non-traumatic epilepsy (NTE) and their associations with various forms of TBI through a retrospective cohort study of U.S. military veterans. NTE was defined as the lack of TBI before epilepsy diagnosis date, while TBIs were split into five categories: skull/facial fracture, diffuse cerebral, focal cerebral, extracerebral or concussion, based on ICD codes.

The researchers collected and analyzed data from the Veterans Health Administration (VA), which identified 210,182 individuals diagnosed with epilepsy between 2005 to 2022. All patients also had documented PTE within 5 years of their epilepsy diagnosis date. Mortality rate in PTE was higher compared with NTE and varied between different TBI classifications. The highest was for those with skull/facial fracture followed by diffuse cerebral injury, then focal cerebral injury. However, those in the NTE group with underlying concussion logged a mortality rate lower than all NTE combined.

Haneef noted that, for the first time, these findings demonstrate an increase in mortality with PTE, particularly among some subtypes of PTE associated with certain mechanisms of underlying head injury.

“These findings will help increase awareness of the seriousness of PTE among physicians, potentially leading to earlier diagnosis and higher priority care, help the public and policy makers be aware of the challenges of these patients, and help advocate and fund further research and support for this patient group,” Haneef said. “This also helps future researchers look into the reasons underlying increased mortality and how it can be prevented.”

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