2018 ERP Investigator Vignette

Title: Resolving the Connection Between TBIs and Epilepsy

Investigator: Karen Parko, MD, Department of Veterans Affairs, Epilepsy Centers of Excellence

Epilepsy is a very prevalent disease. One in 25 people will develop epilepsy, but there’s very little research funding being put into epilepsy. And if you look at where research funding is put into, in terms of its importance within the DoD, epilepsy should be a top priority. It’s a sequelae of traumatic brain injury, and traumatic brain injury is a signature injury of the Afghanistan and Iraq conflicts. So looking at what happens with epilepsy and psychogenic non-epileptic spells after traumatic brain injury is particularly important for the military.

Psychogenic non-epileptic seizures are a common problem in all monitoring units in the United States, and if you look across the board, about 25 percent of the people that come into monitoring units end up with a diagnosis of psychogenic non-epileptic seizures. In the VA, that number is a little bit higher, and there are studies that are looking into etiology of psychogenic non-epileptic seizures. But certainly traumatic brain injury, especially mild traumatic brain injury and post-traumatic stress disorder, is highly associated with them.

Psychogenic non-epileptic seizures are events that look exactly like seizures, but they’re not caused from abnormal electrical discharges in the brain. We don’t know exactly what it stems from, but we believe it stems from underlying unresolved conflict, psychological conflict or processing of conflict. It’s associated with childhood depravity and trauma.

It’s very difficult to distinguish seizures and non-epileptic seizures, and often it requires monitoring in an epilepsy monitoring unit where you can look at what a person is doing on video and read the EEG at the same time. And it’s the correlation of the EEG activity and the physical signs that allows you to tell the difference.

Because they look so similar, people are more commonly diagnosed as having epilepsy when they have psychogenic non-epileptic spells. And the treatment for those different classes is very different. Epileptic seizures, of course, hopefully respond to anti-convulsants or anti-seizure drugs, where psychogenic non-epileptic seizures don’t respond to those types of drugs. In fact, sometimes it can make them worse. So it’s important to distinguish them so that you can treat them.

A really strong focus of the DoD Epilepsy Research Program is epidemiology, specifically, longitudinal epidemiology. When you look at epilepsy itself and understanding it, and understanding the development of epilepsy after traumatic brain injury, there are a lot of things that aren't known. And the big things that this group is interested in answering is what happens with mild traumatic brain injury. And we know from prior conflicts that severe brain injury leads to epilepsy, and we know some of the outcome measures with that. We don’t know what happens with mild traumatic brain injury as well, and we don’t know what happens with blast. So the DoD is interested specifically in looking at what happens to those Service members who sustain a traumatic brain injury. What are their risks of developing epilepsy, and how long does that risk last for?

One of the many reasons the DoD would be interested in understanding risk factors for epilepsy is it’s possible that you could avoid those risk factors and make your chances of developing epilepsy after traumatic brain injury less.

The DoD likes to encourage new investigators to look at problems and to team. Often times, clinically traumatic brain injury is taken care of by physical medicine and rehabilitation physicians, and epilepsy is usually handled clinically by neurologists. And psychogenic non-epileptic spells can sometimes be handled by psychiatry. So to get those three specialties working together, collaborating together, and hopefully submitting grant proposals together is a great way to get cross-talk in the field and to try to encourage people that don’t necessarily work together to work together.

The DoD Epilepsy Research Program is very open to high-risk, potential high-gain solutions. The DoD can be more creative than some other grant mechanisms. So I’d love researchers to bring their most creative foot forward and submit a proposal that could change, really, the landscape of epilepsy and change lives of people with epilepsy.