TBI Before or Soon After Epilepsy Diagnosis Associated With Increased Mortality Risk

Mortality was significantly higher among post-9/11 military veterans with epilepsy who had a traumatic brain injury (TBI) before epilepsy or who experienced a TBI within 6 months of their epilepsy diagnosis, according to a study published online in Epilepsia.

“Veterans with epilepsy with TBI within 6 months after epilepsy or TBI before epilepsy had approximately 4 times higher hazard ratios for mortality than those without epilepsy or TBI, and these results were similar in analysis stratified by TBI severity,” wrote corresponding author Mary Jo Pugh, PhD, RN, University of Utah School of Medicine and the Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah, and study coauthors. “This suggests a TBI diagnosis date proximal to an epilepsy diagnosis date is a strong indicator of increased risk for mortality.”

The study included nearly 1 million veterans who received care in the Defense Health Agency and the Veterans Health Administration between 2000 and 2019. Researchers categorized patients into six groups: (1) controls (no TBI, no epilepsy), (2) TBI only, (3) epilepsy only, (4) TBI before epilepsy, (5) TBI within 6 months after epilepsy, and (6) TBI more than 6 months after epilepsy. The epilepsy index date was the date of first antiseizure medication or first seizure.

Among veterans, 27 436 had epilepsy and 264 890 had a TBI. Over a median follow-up of 7.1 years, all-cause mortality was 6.26% for veterans with epilepsy and 1.12% for controls, according to the study.

Compared with controls, the mortality hazard ratio was highest for veterans who experienced a TBI within 6 months after epilepsy at 5.02. Next highest was veterans with a TBI before epilepsy, who had a mortality hazard ratio of 4.25, the study found.

Mortality hazard ratios were 4.00 for veterans with epilepsy only and 2.49 for veterans with a TBI more than 6 months after epilepsy compared with controls.

“This lower mortality rate among veterans with epilepsy who had TBI >6 months after epilepsy may be attributed to better care,” researchers wrote, “perhaps including polytrauma rehabilitation centers that provide acute, comprehensive, and inpatient rehabilitation.”

Reference

Roghani A, Wang C, Henion A, et al. Mortality among veterans with epilepsy: temporal significance of traumatic brain injury exposure. Epilepsia. 2024;00:1-15. https://doi.org/10.1111/epi.18026