Correlates of posttraumatic epilepsy 35 years following combat brain injury.
BACKGROUND
The Vietnam Head Injury Study (VHIS) is a prospective, longitudinal follow-up of 1,221 Vietnam War veterans with mostly penetrating head injuries (PHIs). The high prevalence (45%-53%) of posttraumatic epilepsy (PTE) in this unique cohort makes it valuable for study.


METHODS
A standardized multidisciplinary neurologic, cognitive, behavioral, and brain imaging evaluation was conducted on 199 VHIS veterans plus uninjured controls, some 30 to 35 years after injury, as part of phase 3 of this study.


RESULTS
The prevalence of seizures (87 patients, 43.7%) was similar to that found during phase 2 evaluations 20 years earlier, but 11 of 87 (12.6%) reported very late onset of PTE after phase 2 (more than 14 years after injury). Those patients were not different from patients with earlier-onset PTE in any of the measures studied. Within the phase 3 cohort, the most common seizure type last experienced was complex partial seizures (31.0%), with increasing frequency after injury. Of subjects with PTE, 88% were receiving anticonvulsants. Left parietal lobe lesions and retained ferric metal fragments were associated with PTE in a logistic regression model. Total brain volume loss predicted seizure frequency.


CONCLUSIONS
Patients with PHI carry a high risk of PTE decades after their injury, and so require long-term medical follow-up. Lesion location, lesion size, and lesion type were predictors of PTE.
Raymont
V
V
Henry M Jackson Foundation, National Naval Medical Center, Bethesda, MD, USA.
Salazar
A M
AM
Lipsky
R
R
Goldman
D
D
Tasick
G
G
Grafman
J
J
D053327:Apolipoprotein E4 / Q000235:genetics; D001930:Brain Injuries / Q000150:complications* / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology; D002394:Catechol O-Methyltransferase / Q000235:genetics; D003072:Cognition Disorders / Q000209:etiology; D004834:Epilepsy, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology* / Q000235:genetics; D055106:Genome-Wide Association Study; D005968:Glutamate Decarboxylase / Q000235:genetics; D006772:Hospitals, Military; D006801:Humans; D007360:Intelligence / Q000502:physiology; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D009483:Neuropsychological Tests; D016194:Receptors, N-Methyl-D-Aspartate / Q000235:genetics; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D047829:Vietnam Conflict
D053327:Apolipoprotein E4; C409466:NR1 NMDA receptor; D016194:Receptors, N-Methyl-D-Aspartate; D002394:Catechol O-Methyltransferase; D005968:Glutamate Decarboxylase