Semin Neurol 2015; 35(01): 057-063
DOI: 10.1055/s-0035-1544239
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Approach to Posttraumatic Epilepsy

Vikram R. Rao
1   Department of Neurology, University of California, San Francisco, California
,
Karen L. Parko
1   Department of Neurology, University of California, San Francisco, California
2   Department of Neurology, San Francisco Veterans Affairs Medical Center, San Francisco, California
› Author Affiliations
Further Information

Publication History

Publication Date:
25 February 2015 (online)

Abstract

Traumatic brain injury (TBI) is one of the most common causes of acquired epilepsy, and posttraumatic epilepsy (PTE) results in significant somatic and psychosocial morbidity. The risk of developing PTE relates directly to TBI severity, but the latency to first seizure can be decades after the inciting trauma. Given this “silent period,” much work has focused on identification of molecular and radiographic biomarkers for risk stratification and on development of therapies to prevent epileptogenesis. Clinical management requires vigilant neurologic surveillance and recognition of the heterogeneous endophenotypes associated with PTE. Appropriate treatment of patients who have or are at risk for seizures varies as a function of time after TBI, and the clinician's armamentarium includes an ever-expanding diversity of pharmacological and surgical options. Most recently, neuromodulation with implantable devices has emerged as a promising therapeutic strategy for some patients with refractory PTE. Here, we review the epidemiology, diagnostic considerations, and treatment options for PTE and develop a roadmap for providers encountering this challenging clinical entity.