severe head injuries and increased risk of epilepsy

Patients who have severe head injuries have 22 times the normal risk of having epilepsy in the year following injury and seven times the normal risk even 10 years after the initial injury, according to the results of a study. The results were presented at the 61st Annual Meeting of the American Epilepsy Society (AES) by Per Sidenius, MD, Epilepsy Epidemiology Consultant, Department of Clinical Pharmacology, University of Aarhus.

Doctors and colleagues identified 73,326 individuals with mild brain injury, 5,099 with skull fracture, and 3,850 with severe brain injury. A total of 17,470 people born within the time period had a diagnosis of epilepsy, and of these, 1,031 developed epilepsy after some form of brain injury.Among patients with mild brain injury and those with skull fracture 1.14% and 1.5%, respectively, developed epilepsy in the 10 years following head injuries, whereas 3% of individuals with severe brain injury developed epilepsy in this time period.

Although the relative risk for epilepsy with mild brain injury and skull fracture was higher in the first year following the head injury, the long-term risk was about double that of the general population [relative risk (RR) 2.22 and 2.17, respectively, with 95% confidence intervals (CI) of 2.07-2.38 and 1.73-2.71, respectively].

The relative risk for epilepsy in the year following a severe head injury was approximately 22 times the risk for the general population with an ongoing relative risk of over seven times the risk for the general population (RR 7.40, 95% CI 6.16-8.89). When the researchers examined other risk factors, they found that a family history of epilepsy resulted in an even greater long-term relative risk for individuals with all three injury types (mild brain injury RR 5.75, 95% CI 4.56-7.27, P=.03; skull fracture RR 2.71, 95% CI 0.87-8.41, P=.04; severe brain injury RR 10.09, 95% CI 4.20-24.26, P <.00001).

Anecdotal evidence of a link between head trauma and increased risk of epilepsy has been a part of epilepsy care for a long time, but doctors emphasised that this study provides an empirical basis for this link and quantifies the risk. Physicians caring for patients with severe head trauma now have the evidence to support continued evaluation and possibly prophylactic care for these patients. These results should encourage additional attention to safety among the general population. "If you prevent head injuries, for example by giving your children bicycle helmets, you are also preventing epilepsy."

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