Management of post-traumatic epilepsy: An evidence review over the last 5 years and future directions

Abstract

Post-traumatic epilepsy (PTE) is a relatively underappreciated condition that can develop as a secondary consequence following traumatic brain injury (TBI). The aim of this rapid evidence review is to provide a synthesis of existing evidence on the effectiveness of treatment interventions for the prevention of PTE in people who have suffered a moderate/severe TBI to increase awareness and understanding among consumers. Electronic medical databases (n = 5) and gray literature published between January 2010 and April 2015 were searched for studies on the management of PTE. Twenty-two eligible studies were identified that met the inclusion criteria. No evidence was found for the effectiveness of any pharmacological treatments in the prevention or treatment of symptomatic seizures in adults with PTE. However, limited high-level evidence for the effectiveness of the antiepileptic drug levetiracetam was identified for PTE in children. Low-level evidence was identified for nonpharmacological interventions in significantly reducing seizures in patients with PTE, but only in a minority of cases, requiring further high-level studies to confirm the results. This review provides an opportunity for researchers and health service professionals to better understand the underlying pathophysiology of PTE to develop novel, more effective therapeutic targets and to improve the quality of life of people with this condition.

Keywords: Community; Epilepsy; Late seizures; Management; Traumatic brain injury.

Figure 1

Major events following post‐traumatic epilepsy (PTE) over time. Figure summarizes the major events (red shaded boxes) that occur over time following TBI with the potential development of PTE and its establishment into a chronic condition. With time there are also key periods (blue shaded boxes) that contribute to the major events (red shaded boxes), including epileptogenesis that is known as the “window of opportunity” in which antiepileptogenic or disease‐modifying interventions are prescribed (green shaded boxes). Once PTE has developed, management focuses on controlling the symptoms (green shaded boxes). Although, the intended goal in management is to work toward eliminating seizures so the person will be seizure‐free, this is yet to be achieved in research and clinical practice.

Figure 2

Flow chart of the number of studies included in the rapid review.34