Talk:Post-traumatic epilepsy
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A fact from Post-traumatic epilepsy appeared on Wikipedia's Main Page in the Did you know? column on March 6, 2008. |
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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)
[edit] 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)
[edit] A bit of research
Some sources on Google Books
Done Yudofsky, Stuart C.; Silver, Jonathan M.; McAllister, Thomas G. (2005). Textbook Of Traumatic Brain Injury. Washington, DC: American Psychiatric Association, 309-321. ISBN 1-58562-105-6.
- Chapter 16 has a section on seizures.
- Done Swash, Michael (1998). Outcomes in neurological and neurosurgical disorders. Cambridge, UK: Cambridge University Press, 172. ISBN 0-521-44327-X.
- Done Dodson, W. Edwin; Giuliano Avanzini; Shorvon, Simon D.; Fish, David R.; Emilio Perucca (2004). The treatment of epilepsy. Oxford: Blackwell Science, 775-. ISBN 0-632-06046-8.
- Chapter 64: Surgery of Post-Traumatic Epilepsy
- Done Daniel L. Barrow (1992). Complications and sequelae of head injury. Park Ridge, Ill: American Association of Neurological Surgeons, 127-132. ISBN 1-879284-00-6.
- 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 Its age means that some definitions may have been superseded.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.
- Hauser WA, Annegers JF, Kurland LT (1991). "Prevalence of epilepsy in Rochester, Minnesota: 1940-1980". Epilepsia 32 (4): 429–45. PMID 1868801.
- (not free) This is the definitive epidemiological study of epilepsy, and the one where the 5% figure comes from.
- Garga N, Lowenstein DH (2006). "Posttraumatic epilepsy: a major problem in desperate need of major advances". Epilepsy Curr 6 (1): 1–5. doi:. PMID 16477313.
- 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.
- Done Chang BS, Lowenstein DH (2003). "Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury: report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology 60 (1): 10–6. PMID 12525711.
- 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.
- Massagli T (1992). "Prophylaxis and treatment of posttraumatic epilepsy with phenytoin". West. J. Med. 157 (6): 663–4. PMID 1475952.
- Written after Temkin's 1990 study, this confirms the tradition of one year of prophylaxis but recommends only one week.
- "Post-traumatic epilepsy" (1978). Br Med J 2 (6132): 229. PMID 98198.
- 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.
- Jennett WB (1965). "Predicting epilepsy after blunt head injury". Br Med J 1 (5444): 1215–6. PMID 14275018.
- 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)
