Correlates of posttraumatic epilepsy 35 years following combat brain injury

The Vietnam Head Injury Study (VHIS) is a prospective, longitudinal follow-up of 1,221 Vietnam War veterans with mostly penetrating head injuries (PHIs). The high prevalence (45%-53%) of posttraumatic epilepsy (PTE) in this unique cohort makes it valuable for study. A standardized multidisciplinary...

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Bibliographic Details
Published in:	Neurology Vol. 75; no. 3; pp. 224 - 229
Main Authors:	RAYMONT, V, SALAZAR, A. M, LIPSKY, R, GOLDMAN, D, TASICK, G, GRAFMAN, J
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins 20-07-2010 American Academy of Neurology
Subjects:	Apolipoprotein E4 - genetics Biological and medical sciences Brain Injuries - complications Brain Injuries - epidemiology Brain Injuries - genetics Brain Injuries - pathology Catechol O-Methyltransferase - genetics Cognition Disorders - etiology Epilepsy, Post-Traumatic - epidemiology Epilepsy, Post-Traumatic - etiology Epilepsy, Post-Traumatic - genetics Genome-Wide Association Study Glutamate Decarboxylase - genetics Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Hospitals, Military Humans Intelligence - physiology Longitudinal Studies Magnetic Resonance Imaging - methods Male Medical sciences Middle Aged Nervous system (semeiology, syndromes) Neurologic Examination - methods Neurology Neuropsychological Tests Receptors, N-Methyl-D-Aspartate - genetics Time Factors Tomography, X-Ray Computed - methods Vietnam Conflict Nervous system diseases Epilepsy Central nervous system disease Cerebral disorder
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Summary:	The Vietnam Head Injury Study (VHIS) is a prospective, longitudinal follow-up of 1,221 Vietnam War veterans with mostly penetrating head injuries (PHIs). The high prevalence (45%-53%) of posttraumatic epilepsy (PTE) in this unique cohort makes it valuable for study. A standardized multidisciplinary neurologic, cognitive, behavioral, and brain imaging evaluation was conducted on 199 VHIS veterans plus uninjured controls, some 30 to 35 years after injury, as part of phase 3 of this study. The prevalence of seizures (87 patients, 43.7%) was similar to that found during phase 2 evaluations 20 years earlier, but 11 of 87 (12.6%) reported very late onset of PTE after phase 2 (more than 14 years after injury). Those patients were not different from patients with earlier-onset PTE in any of the measures studied. Within the phase 3 cohort, the most common seizure type last experienced was complex partial seizures (31.0%), with increasing frequency after injury. Of subjects with PTE, 88% were receiving anticonvulsants. Left parietal lobe lesions and retained ferric metal fragments were associated with PTE in a logistic regression model. Total brain volume loss predicted seizure frequency. Patients with PHI carry a high risk of PTE decades after their injury, and so require long-term medical follow-up. Lesion location, lesion size, and lesion type were predictors of PTE.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0028-3878 1526-632X
DOI:	10.1212/WNL.0b013e3181e8e6d0