By Dr. Rosabel Young M.S., M.D.

I get many questions about epilepsy after brain injury.

A seizure refers to an episode of altered perception or behavior that occurs because of abnormal brainwave activity. The areas of the brain that have been damaged may develop abnormal electrical activity and this can be experienced as fainting spells or sudden episodes of confusion, loss of speech, word-finding difficulties, and sometimes partial or full body convulsions.

Immediately or within a few days after a brain injury, the brain may have small areas of bleeding and swelling. These act like irritants to brain tissue and can trigger one or several seizures. As the blood dissolves away and the swelling goes down, as can be seen with imaging studies like brain MRI, these “early post-traumatic seizures” resolve, or at least they are not likely to develop into permanent epilepsy. Typically, emergency room doctors will treat with antiseizure medications for one week, but the medical literature supports that it is safer to treat for 4 to 6 weeks in these patients because it takes four to six weeks for the small bleeds and swelling to resolve.

If it seems that the symptoms have gone away or are improving over the next few months and then seizures develop six months later or more, the cause is due to scar tissue that has taken months to develop. Unfortunately, persons with “late post-traumatic seizures” are more likely to develop chronic epilepsy, and those seizures do need to be treated for the long term. According to the medical literature, post-traumatic seizures can first appear up to 18 months later, and in my clinical practice, it is common for patients to be unaware of seizure symptoms until years later. Epilepsy can develop even in late adulthood as a result of a brain injury in childhood.

Therefore, all patients with brain injury who experience lapses of awareness, memory loss, involuntary movements, or have abnormal findings on physical neurological examination should have a head CT scan, Electroencephalography, and brain MRI. These tests should be done even if there is no loss of consciousness at the time of the injury.

I will talk about the different types of epilepsy and how they are treated in another podcast including different types at different ages with and without trauma.