The Military Injuries: Understanding Post-Traumatic Epilepsy Study: Understanding Relationships among Lifetime Traumatic Brain Injury History, Epilepsy, and Quality of Life

Pugh, Mary Jo; Kennedy, Eamonn; Gugger, James J; Mayo, Jamie N.; Tate, David F.; Swan, Alicia A.; Kean, Jacob; Altalib, Hamada; Gowda, Shaila; Towne, Alan R.; Hinds, Sidney; Cott, Anne Van; López, María Fernanda; Eapen, Blessen C.; McCafferty, Randall; Salinsky, Martin; Cramer, Joyce A.; McMillan, Katherine K.; Kalvesmaki, Andrea; Amuan, Megan E.; Henion, Amy; Padilla, Silvia; McCafferty, Mary Katherine; Elizondo, Barbara; Wells, Margaret

doi:10.1089/neu.2021.0015

Cited by 16 publications

(20 citation statements)

References 45 publications

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“…Another limitation of this work is the potential for ascertainment bias for epilepsy. 6 To minimize this, we used a robust epilepsy identification algorithm and chart review of medical records for all patients with epilepsy identified by the algorithm to minimize the likelihood of misclassifying those with provoked seizures and nonepileptic events as having epilepsy. Unfortunately, given that most of the data are collected via survey, we were not able to reliably determine whether ASMs were appropriately dosed as required in the International League Against Epilepsy definition of DRE.…”

Section: Discussionmentioning

confidence: 99%

“…As part of a larger study examining the impact of epilepsy and mild TBI (mTBI) on health outcomes, we identified veterans with TBI and/or epilepsy using VHA health system data for subsequent survey administration. 6…”

Section: Methodsmentioning

confidence: 99%

“…As described in prior work, 6 surveys measuring lifetime TBI history, PTE screening, indicators of DRE, and measures of health status and QOL were administered to the cohort between September 2017 and February 2019 (receipt date cutoff, July 31, 2019). Mailed invitation packets included a study information sheet and a link to the online survey.…”

Section: Methodsmentioning

confidence: 99%

“…30 Prior work using this sample found that mental (MCS) and physical (PCS) component scores were better for veterans with no TBI and veterans without epilepsy. 6 We used the MCS and PCS from the VR-12 as dependent variables in this analysis. The Short Form-6D items of the VR-12 were used to calculate quality-adjusted life-years (QALY) and quality-adjusted life expectancy (QALE).…”

Section: Survey Measuresmentioning

confidence: 99%

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Multimodal Quality of Life Assessment in Post-9/11 Veterans With Epilepsy

et al. 2022

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Background and Objectives:Epilepsy is defined by the occurrence of multiple unprovoked seizures, but quality of life (QOL) in people with epilepsy is determined by multiple factors, in which psychiatric comorbidities play a pivotal role. Therefore, understanding the interplay between comorbidities and QOL across epilepsy phenotypes is an important step towards improved outcomes. Here, we report the impact of QOL across distinct epilepsy phenotypes in a cohort of post-9/11 veterans with high rates of traumatic brain injury (TBI).Methods:This observational cohort study from the Veterans Health Administration included post-9/11 Veterans with epilepsy. A process integrating an epilepsy identification algorithm, chart abstraction, and self-reported measures was used to classify patients into one of four groups: 1. Epilepsy controlled with medications, 2. Drug resistant epilepsy (DRE), 3. Post-traumatic epilepsy (PTE), or 4. Drug resistant post-traumatic epilepsy (PT-DRE). Summary scores for six QOL measures were compared across the groups, adjusting for age, sex, and number of comorbidities.Results:A total of 529 survey respondents with epilepsy were included in the analysis: 249 controls (i.e., epilepsy without DRE or PTE), 124 with DRE, 86 with PTE, and 70 with PT-DRE. Drug resistant epilepsy was more common in those with PTE compared with non-traumatic epilepsy (45% vs. 33%, odds ratio 1.6 (95% CI: [1.1-2.4], p=0.01)). Patients with PTE and PT-DRE had significantly more comorbid conditions in health records than those with nontraumatic epilepsy. Those with both PTE and DRE reported the lowest QOL across all six measures, and this persisted after adjustment for comorbidities, and in further linear analyses.Discussion:Among those with PTE, DRE prevalence was significantly higher than for non-traumatic epilepsies. PTE was also associated with higher burden of comorbidity, and worse overall QOL compared to those with non-traumatic epilepsies. People with PTE are distinctly vulnerable to the comorbidities associated with TBI and epilepsy. This at-risk group should be the focus of future studies aimed at elucidating the factors associated with adverse health outcomes and developing anti-epileptogenic therapies.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Survey Measuresmentioning

confidence: 99%

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Multimodal Quality of Life Assessment in Post-9/11 Veterans With Epilepsy

et al. 2022

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“…Data from the Department of Veterans Affairs’ (VA) comprehensive TBI evaluation have shown that veterans with PTE have significantly higher cognitive, affective, somatosensory, and vestibular symptom burdens than those with mTBI only. A survey-based study found that veterans with PTE had significantly lower quality of life, social support, and family resilience scores compared with those with epilepsy, mTBI, and control participants with neither TBI nor epilepsy [ 22 ]. Given the relatively young age of post-9/11 veterans, the costs of care (both personal and financial) may profoundly affect the lives of these veterans, their caregivers or families, and the health care systems on which they depend for care.…”

Section: Introductionmentioning

confidence: 99%

Military Injuries—Understanding Posttraumatic Epilepsy, Health, and Quality-of-Life Effects of Caregiving: Protocol for a Longitudinal Mixed Methods Observational Study

Bouldin¹,

Delgado²,

Peacock³

et al. 2022

JMIR Res Protoc

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Background Veterans with posttraumatic epilepsy (PTE), particularly those with comorbidities associated with epilepsy or traumatic brain injury (TBI), have poorer health status and higher symptom burden than their peers without PTE. One area that has been particularly poorly studied is that of the role of caregivers in the health of veterans with PTE and the impact caring for someone with PTE has on the caregivers themselves. Objective In this study, we aim to address the following: describe and compare the health and quality of life of veterans and caregivers of veterans with and without PTE; evaluate the change in available supports and unmet needs for services among caregivers of post-9/11 veterans with PTE over a 2-year period and to compare support and unmet needs with those without PTE; and identify veteran and caregiver characteristics associated with the 2-year health trajectories of caregivers and veterans with PTE compared with veterans without PTE. Methods We conducted a prospective cohort study of the health and quality of life among 4 groups of veterans and their caregivers: veterans with PTE, nontraumatic epilepsy, TBI only, and neither epilepsy nor TBI. We will recruit participants from previous related studies and collect information about both the veterans and their primary informal caregivers on health, quality of life, unmet needs for care, PTE and TBI symptoms and treatment, relationship, and caregiver experience. Data sources will include existing data supplemented with primary data, such as survey data collected at baseline, intermittent brief reporting using ecological momentary assessment, and qualitative interviews. We will make both cross-sectional and longitudinal comparisons, using veteran-caregiver dyads, along with qualitative findings to better understand risk and promotive factors for quality of life and health among veterans and caregivers, as well as the bidirectional impact of caregivers and care recipients on one another. Results This study was approved by the institutional review boards of the University of Utah and Salt Lake City Veterans Affairs and is under review by the Human Research Protection Office of the United States Army Medical Research and Development Command. The Service Member, Veteran, and Caregiver Community Stakeholders Group has been formed and the study questionnaire will be finalized once the panel reviews it. We anticipate the start of recruitment and primary data collection by January 2022. Conclusions New national initiatives aim to incorporate the caregiver into the veteran’s treatment plan; however, we know little about the impact of caregiving—both positive and negative—on the caregivers themselves and on the veterans for whom they provide care. We will identify specific needs in this understudied population, which will inform clinicians, patients, families, and policy makers about the specific impact and needs to equip caregivers in caring for veterans at home. International Registered Report Identifier (IRRID) PRR1-10.2196/30975

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Posttraumatic Epilepsy and Dementia Risk

Schneider,

Law,

Gottesman

et al. 2024

JAMA Neurol

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ImportanceAlthough both head injury and epilepsy are associated with long-term dementia risk, posttraumatic epilepsy (PTE) has only been evaluated in association with short-term cognitive outcomes.ObjectiveTo investigate associations of PTE with dementia risk.Design, Setting, and ParticipantsThe Atherosclerosis Risk in Communities (ARIC) study initially enrolled participants from 1987 to 1989 and this prospective cohort study uses data through December 31, 2019, with a median follow-up of 25 years. Data were analyzed between March 14, 2023, and January 2, 2024. The study took place in 4 US communities in Minnesota, Maryland, North Carolina, and Mississippi. Of 15 792 ARIC study participants initially enrolled, 2061 were ineligible and 1173 were excluded for missing data, resulting in 12 558 included participants.ExposuresHead injury was defined by self-report and International Classification of Diseases (ICD) diagnostic codes. Seizure/epilepsy was defined using ICD codes. PTE was defined as a diagnosis of seizure/epilepsy occurring more than 7 days after head injury. Head injury, seizure/epilepsy, and PTE were analyzed as time-varying exposures.Main Outcomes and MeasuresDementia was defined using cognitive assessments, informant interviews, and ICD and death certificate codes. Adjusted Cox and Fine and Gray proportional hazards models were used to estimate dementia risk.ResultsParticipants had a mean (SD) age of 54.3 (5.8) years at baseline, 57.7% were female, 28.2% were of self-reported Black race, 14.4% were ultimately categorized as having head injury, 5.1% as having seizure/epilepsy, and 1.2% as having PTE. Over a median follow-up of 25 (25th to 75th percentile, 17-30) years, 19.9% developed dementia. In fully adjusted models, compared with no head injury and no seizure/epilepsy, PTE was associated with 4.56 (95% CI, 4.49-5.95) times the risk of dementia, while seizure/epilepsy was associated with 2.61 (95% CI, 2.21-3.07) times the risk and head injury with 1.63 (95% CI, 1.47-1.80) times the risk. The risk of dementia associated with PTE was significantly higher than the risk associated with head injury alone and with nontraumatic seizure/epilepsy alone. Results were slightly attenuated in models accounting for the competing risks of mortality and stroke, but patterns of association remained similar. In secondary analyses, the increased dementia risk associated with PTE occurring after first vs second head injury and after mild vs moderate/severe injury was similar.Conclusions and RelevanceIn this community-based cohort, there was an increased risk of dementia associated with PTE that was significantly higher than the risk associated with head injury or seizure/epilepsy alone. These findings provide evidence that PTE is associated with long-term outcomes and supports both the prevention of head injuries via public health measures and further research into the underlying mechanisms and the risk factors for the development of PTE, so that efforts can also be focused on the prevention of PTE after a head injury.

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The Military Injuries: Understanding Post-Traumatic Epilepsy Study: Understanding Relationships among Lifetime Traumatic Brain Injury History, Epilepsy, and Quality of Life

Cited by 16 publications

References 45 publications

Multimodal Quality of Life Assessment in Post-9/11 Veterans With Epilepsy

Multimodal Quality of Life Assessment in Post-9/11 Veterans With Epilepsy

Military Injuries—Understanding Posttraumatic Epilepsy, Health, and Quality-of-Life Effects of Caregiving: Protocol for a Longitudinal Mixed Methods Observational Study

Posttraumatic Epilepsy and Dementia Risk

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