Talk:Post-traumatic epilepsy

The literature frequently uses "post-traumatic seizures" when referring to the chronic condition, maybe because it's broader (they definitely have seizures, but it's harder to diagnose epilepsy). I've been using PTE when a source says "seizure disorder" but when it just uses PTS, I've been putting it in the PTS article. delldot  talk  22:18, 1 March 2008 (UTC)

Comments from Colin
I'm copying these from my talk page so they're accessible to everyone. delldot  talk  00:15, 4 March 2008 (UTC)

A bit of research
Some sources on Google Books


 * Chapter 16 has a section on seizures.
 * Chapter 16 has a section on seizures.


 * Chapter 64: Surgery of Post-Traumatic Epilepsy
 * Chapter 64: Surgery of Post-Traumatic Epilepsy
 * Chapter 64: Surgery of Post-Traumatic Epilepsy


 * Chaptre 8: Post-Traumatic Epilepsy
 * Chaptre 8: Post-Traumatic Epilepsy

Jennet's 1975 book ("Epilepsy after Non-Missile Injuries", 2nd Edition, 1975) appears to be the definitive work from which others are based. Its age means that some definitions may have been superseded. If you can get hold of this book, your articles would benefit immensely.

Temkin's 1990 study ("A randomized double-blind study of phenytoin for the prevention of post-traumatic seizures" N Engl J Med 323:497-502, 1990) seems to be the critical study into prophylaxis.

Jennet is responsible for the classification into early and late post-traumatic seizures, with the early form occurring with the first week. This definition still holds. Some have suggested a refinement to consider the first day as another threshold. Several sources state "One third of early seizures occur within the first hour of injury, another one-third within the first day, and the last one-third during the remainder of the first week" -- including bowen 1992 delldot   talk  22:49, 6 March 2008 (UTC)

The Textbook Of Traumatic Brain Injury says "Technically, if seizures occur after the first week postinjury and are recurrent, the term post-traumatic epilepsy should be used, but the literature uses the terms posttraumatic seizures and posttraumatic epilepsy interchangeably, and most seem to favor the use of posttraumatic seizures.

I'd say we can classify post-traumatic seizures into two groups: early (within 7 days of injury) and late. The early group can be further subdivided such that immediate seizures occur within 24 hours of injury.

The issue is that if one has epilepsy, then one also has seizures. But one may have seizures without epilepsy (i.e., if they are provoked). It is safer for authors to use the term "seizures" since they are observable unambiguous events that may be counted and dated. The transition from saying "these seizures are caused by the original injury" (provoked) to "these seizures are due to the long-term brain damage" (unprovoked)" is the key to the use of the term "epilepsy". The "one week" threshold is, according to most, rather arbitrary. Your source for the provoked/unprovoked distinction is using the early=provoked late=unprovoked grouping in an approximate manner. They aren't directly equivalent due to the arbitrary nature of the 7 day cut-off.


 * (not free) This is the definitive epidemiological study of epilepsy, and the one where the 5% figure comes from.
 * (not free) This is the definitive epidemiological study of epilepsy, and the one where the 5% figure comes from.


 * This reports that one study suggests even a single late seizure should be a strong indication to initiate antiepileptic drug treatment. A few people define epilepsy as a propensity to recurrent seizures rather than have a history of recurrent seizures. That would effectively diagnose these people with epilepsy due to the injury + one seizure.
 * This reports that one study suggests even a single late seizure should be a strong indication to initiate antiepileptic drug treatment. A few people define epilepsy as a propensity to recurrent seizures rather than have a history of recurrent seizures. That would effectively diagnose these people with epilepsy due to the injury + one seizure.


 * This is your expert report you need to give current best-practice recommendations on prophylaxis. They recommend prophylactic treatment with phenytoin for one week in cases of severe TBI. They discourage the routing use after 7 days, and make no recommendation for mild to moderate TBI. The paper also contains useful stats.
 * This is your expert report you need to give current best-practice recommendations on prophylaxis. They recommend prophylactic treatment with phenytoin for one week in cases of severe TBI. They discourage the routing use after 7 days, and make no recommendation for mild to moderate TBI. The paper also contains useful stats.


 * Written after Temkin's 1990 study, this confirms the tradition of one year of prophylaxis but recommends only one week.
 * Written after Temkin's 1990 study, this confirms the tradition of one year of prophylaxis but recommends only one week.


 * Written between Jennet and Temkin, this is somewhat dated. The stats on 7000 PTE cases per year in Britain are interesting. Without the benefit of later studies, the author's repeat a claim that "100,000 Americans develop epilepsy each year because they have not been given prophylactic anticonvulsants" and suggest it is "prudent to continue [anticonvulsants] for at least two years, after which the drug should be tailed off slowly".
 * This article contains an interesting quote from Wilder Penfield that the gap between injury and seizure is "a silent period of strange ripening". Might be worth repeating that.
 * This article contains an interesting quote from Wilder Penfield that the gap between injury and seizure is "a silent period of strange ripening". Might be worth repeating that.


 * This paper by Jennett predates his 1975 book. The early/late distinction (one week) is present even then. He uses the word "epilepsy" in a way that wouldn't be allowed now (for example, to describe a single generalised convulsion one minute after injury). Epilepsy by definition is not provoked and must be recurrent. I think Jennett is the origin of the misuse of seizures/epilepsy terms. Many later author's have preferred to say "seizures" rather than use his words, leading to a mix of usage.
 * This paper by Jennett predates his 1975 book. The early/late distinction (one week) is present even then. He uses the word "epilepsy" in a way that wouldn't be allowed now (for example, to describe a single generalised convulsion one minute after injury). Epilepsy by definition is not provoked and must be recurrent. I think Jennett is the origin of the misuse of seizures/epilepsy terms. Many later author's have preferred to say "seizures" rather than use his words, leading to a mix of usage.

Colin 13:41, 25 February 2008 (UTC) (posted to User talk:Delldot)


 * The sources marked ✅ I've already fully read. delldot   talk  00:15, 4 March 2008 (UTC)

Classification
From the ILAE:


 * ✅Partial (or Focal) – involves only part of one hemisphere of the brain. (or, more simply, involves only part of the brain)
 * ✅Generalised – involves both hemispheres of the brain.

A few comments on classification:


 * ✅The text on partial, "therefore part of the body", is too simplistic and assumes motor signs. A partial seizure might instead affect the senses, the autonomic nervous system, or the mind.
 * ✅The text on generalised, "leading to convulsions of the entire body", isn't always the case, as there are many other effects of generalised seizures and convulsions do not always occur. The "loss of consciousness" is correct, though it can be brief.
 * ✅"they may have a focal onset and then proceed to affect the entire body (a phenomenon known as "secondary generalization")" This uses the word "focal" without informing the reader that it is synonym for partial. It repeats the "entire body" (see point above). It might be simpler to just say that sometimes generalised seizures begin as partial seizures, which spread. The reader of this article probably doesn't need to have "secondary generalization" defined, unless you intend to use it again (e.g., in the epidemiology).
 * ✅"while partial seizures increase in prevalence as time passes after the injury" might be read to mean they become more common/frequent with time rather than become the more common form of seizure.

I would offer to revise the text here but it is getting late for me tonight, and I'd have to use different sources from yours. Colin°Talk 21:31, 26 July 2008 (UTC)


 * Thanks much for the accuracy check Colin, I think these are fixed now. About the last point, neither the ref cited or the paper it cites is clear on which meaning: "[complex partial] and [partial with generalization] seizures are most common after the first week", says


 * Reading that, it looks like this info has more relevance to post-traumatic seizure anyway, since it's mainly covering the first week after TBI, so I'm going to take this info out.


 * Thanks again, your feedback is always most welcome.  delldot   talk  23:56, 26 July 2008 (UTC)

GA done. Congratulations. JFW | T@lk  21:45, 2 August 2008 (UTC)

Image
This article could use an image in the lead. Not sure what but... Doc James (talk · contribs · email) 03:02, 19 December 2009 (UTC)

Jennett's work
added the following:

It is unlikely that the work of Jennett et al (1972)on the risk factors for post-traumatic epilepsy will be improved upon in the future, and all subsequent studies have merely confirmed their original findings. The principal risk factors in post-traumatic non-missile civilian head injury remain the presence of a penetrating injury with a dural tear, a haematoma, early epilepsy and PTA of > 24 hours. In the worst case scenario (all 4 factors) the risk is over 70%, falling to under 3% if none are present.(see Jennett B. Epilepsy after Non-Missile head injuries. Heinemann London 1975)

This may be true, except this is written in Wikipedia's voice without a source. I am sure that it is correct, but we cannot say it without a WP:MEDRS-compatible secondary source. JFW &#124; T@lk  17:08, 25 February 2014 (UTC)