Best of the AANS Session-Discussant The Incidence of Post-Traumatic Epilepsy After TBI A TRACK-TBI Study

Video Transcription

I'm Usma Samadhani. I'll be discussing the incidence of post-traumatic epilepsy after traumatic brain injury, a TRACT-TBI study.  My primary disclosure is that I am one of the TRACT-TBI investigators at one of the multiple sites involved in the study funded by the NIH.  The investigators are to be congratulated on an outstanding prospect of observational study that looked at two major questions, how likely is post-traumatic epilepsy after TBI,  and what is its impact on these patients at 12-month follow-up. They were able to find that there was a 2.7% incidence of post-traumatic epilepsy after brain injury  and that there was a significant impact on follow-up at 12 months as assessed by three different surveyed outcome measures.  The investigators should be encouraged to look further at their data to answer more in-depth questions.  For example, it is known that post-traumatic epilepsy or seizures can be triggered by abnormal conductivity due to multiple different mechanisms associated with brain injury,  such as endocrine dysfunction, cortical spreading, depression, and many, many others.  Because we know that brain injury is so heterogeneous and the people who get brain injuries are heterogeneic  in terms of their genetics, their comorbid conditions, such as alcohol intoxication, I would encourage the investigators to classify the susceptibility and nature of injury better  using things like genetics, algorithmic radiographic measures, serum, and other objective measures.  And finally, the investigators have used all-or-none outcome measures because that's what's available to us, but we have to ask, are these an all-or-none phenomenon  or is aberrant electrical activity after brain injury a continuum of dysfunction? Ultimately, you can't improve what you can't measure,  and it's certainly possible that we're underestimating the amount of dysfunction that's present in these patients.  So to summarize, I want to congratulate the authors on a well-conducted prospective study. I would encourage them that future work should characterize susceptibility  and classify the nature of injury to quantitate risk better. I would caution that we are likely underestimating the non-easily measurable consequences of brain injury.  And finally, the more accurately we can do all of these things, the better we can target acute management and the less aberrant electrical activity our patients will have.

Video Summary

In a video, Usma Samadhani discusses the TRACT-TBI study on post-traumatic epilepsy after traumatic brain injury. The study found a 2.7% incidence of post-traumatic epilepsy and significant impact on patients at 12-month follow-up. Samadhani suggests further analysis of the data to understand the various mechanisms that trigger seizures after brain injury. The heterogeneity of brain injuries and patients' genetics and comorbid conditions should be considered. Samadhani encourages characterizing susceptibility and injury nature using genetics, radiographic measures, and objective markers. All-or-none outcome measures may underestimate dysfunction, so better measurement methods are needed. The study is commended for its quality and future work should aim to better quantify risks and improve acute management.

Keywords

post-traumatic epilepsy

traumatic brain injury

seizure triggers

genetics

acute management