title: Traumatic brain injury and psychogenic seizures in veterans.
abstract: OBJECTIVE
  To evaluate a proposed seizure etiology of traumatic brain injury (TBI) as a risk factor for psychogenic nonepileptic seizures (PNESs), the effect of reported TBI severity on the diagnosis of PNES versus epileptic seizures (ESs), and the potential moderating role of posttraumatic stress disorder (PTSD).
  
  
  METHODS
  Veterans with a diagnosis of PNES or ES during epilepsy monitoring at a Veterans Affairs Medical Center.
  
  
  METHODS
  Retrospective review of seizure type, proposed seizure etiology, TBI severity, and PTSD.
  
  
  RESULTS
  Both PNES and ES groups were compared for TBI history and severity, and prior diagnosis of PTSD.
  
  
  RESULTS
  Traumatic brain injury was the proposed seizure etiology for 57% of 67 PNES patients versus 35% of 54 ES patients (P < .05). It was mild in 87% of PNES patients and 37% of ES patients (P < .001). Posttraumatic stress disorder increased the likelihood of diagnosing PNES versus ES in Veterans with mild TBI as the proposed seizure etiology.
  
  
  CONCLUSIONS
  Veterans with PNES commonly cite a TBI as the cause for seizures. Mild TBI was strongly associated with PNES versus ES. Posttraumatic stress disorder may moderate the development of PNES in Veterans with a history of mild TBI. Clinicians caring for Veterans with seizures may use these results in selecting patients for early diagnostic evaluation.
authors.affiliation: Portland Veterans Affairs Medical Center (Drs Salinsky, Storzbach, and Goy and Ms Evrard), and Oregon Health & Sciences University (Dr Salinsky), Portland, Oregon.
authors.forename: Martin
authors.initials: M
authors.lastname: Salinsky
authors.forename: Daniel
authors.initials: D
authors.lastname: Storzbach
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goy
authors.forename: Collette
authors.initials: C
authors.lastname: Evrard
mesh_terms: D001930:Brain Injuries / Q000150:complications* / Q000453:epidemiology; D015897:Comorbidity; D004827:Epilepsy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D014728:Veterans