Epilepsy is the general term for a variety of neurological conditions characterized by recurrent unprovoked seizures – it’s the fourth most common neurological disorder in the United States. And, approximately 110,000 people in Michigan are diagnosed with epilepsy. In about 60% of cases, there is no known cause. Among the remaining 40%, brain injury is one of the most frequent causes. Most common with brain injuries are partial seizures, which typically arise from scar tissue from the injury. Partial seizures affect only one portion of the brain and have more limited symptoms such as visual distortions, odd sensations, unexplained emotional experiences, or non-purposeful behaviors or jerking movements. Sometimes, partial seizures spread and become generalized (Grand Mal), before they resolve. Grand Mal seizures involve a loss of consciousness and uncontrolled shaking as all muscle groups receive an overload of messages for movement. If a person has more than one seizure in a short period of time without recovering consciousness, or does not resolve a seizure episode within 5 minutes, it is called Status Epilepticus – and is a medical emergency. There are many types of seizures. Any initial occurrence of a seizure warrants medical attention as it is a sign that something is not right with the brain. Common causes are electrolyte imbalance, dehydration, fever, sleep deprivation or exhaustion, a new neurological injury such as bleeding or hydrocephalus, medication or illicit drug side-effects, or genetic predisposition. Some seizures are idiopathic, not known to be caused by anything in particular. Other times, seizures may have no clear physiological component, thought to be caused by neuropsychiatric features. Careful diagnosis of new-onset seizures is critical to appropriate treatment. Approximately 10% of individuals with brain injuries severe enough to require hospitalization have seizures. Seizures at the time of injury are quite common, but are not always an indicator of later problems with seizures. Seizures associated with the time of injury possibly represent a different type of convulsive phenomena. In later appearing seizures, those with open head injuries are associated with a higher risk. There are relationships between the severity and occurrence of injuries. Individuals with a severe traumatic brain injury are 29 times more likely than the general population to have epilepsy. When seizures appear later in recovery they are often more persistent, with 80% experiencing at least one more seizure. When seizures occur, or where sufficient risk factors are present, medication may be required to prevent or control them. In about 80% of cases, seizures can be controlled with medication. For others, surgery may be used to eliminate the likely source of irritation. Behavioral strategies associated with maintaining a healthy lifestyle such as good sleep, diet, hydration, and appropriate medication use are also critical. The effects of substance misuse, like alcohol withdrawal, and misuse of some types of medicines, can also increase seizure risk. There are many implications associated with seizure disorder including safety risks, loss of driving privileges, mortality risks, mental health vulnerabilities, as well as the social stigma still unfairly endured by persons with epilepsy and brain injury. Accommodations can help minimize these influences on adjustment. Support may include allowing additional time for tasks, pacing activities to limit fatigue, managing stimulation levels from noise or distractions, facilitating transportation or providing safe activity alternatives. Such supports help keep people with brain injury and seizures active and included, participating as part of their communities. First aid for seizures is largely supportive, providing protective monitoring with vigilance to provide assistive resuscitation in extreme events. While sometimes a frightening and challenging symptom to manage, people with epilepsy and brain injury have many resources and treatment options to support the successful management of these symptoms. Web Resources:

• Epilepsy Foundation: https://epilepsy.com
• Epilepsy Foundation of Michigan: https://epilepsymichigan.org
• Brain injury-specific information: https://msktc.org/tbi/factsheets/seizures-after-traumatic-brain-injury
• Professional Resources: https://www.aesnet.org/
• En Español: https://msktc.org/lib/docs/Factsheets/Spanish_Factsheets/TBI-Seizures_Sp.pdf

Martin J. Waalkes, Ph.D., ABPP(rp), CBIS-T
Licensed Psychologist
Director of Neuro Rehabilitation
Hope Network Neuro Rehabilitation

Risk Factors for Addiction

• Alcohol/Drug use or dependence prior to obtaining their brain injury
• History of mood disorders
• Current depressive disorder or symptoms of depression
• Addiction to tobacco
• Family history of addiction
• Poor social skills
• Poverty
• Early use in adolescence
• Stress at home
• Unhelpful support group or lack of natural supports
• Lack of health insurance or access to health care

Questions to ask if you fear that you or someone you love may have an addiction and need support

• Do they go through withdrawals if/when they stop using?
• Do they have to take larger amounts or over a longer time period than intended?
• Has their use resulted in a failure to fulfill major obligations at work, school, or home?
• Have they continued to use despite continuous problems with using?
• Have they made unsuccessful attempts to cut down?
• Do they have cravings, or a strong desire to use?
• Have they given up important social, occupational, or recreational activities because of use?
• Do they continue to use in situations where it is physically hazardous?
• Do they continue to use despite knowledge of having physical/psychological dependence?
• Do they spend a great deal of their time obtaining, using, or recovering from its effects?

Want help?

There are many avenues to find support, whether one has commercial insurance, Medicare, Medicaid, or no insurance at all. You can call your local Behavioral Health Authority, and talk to someone who can immediately assess your need for treatment and link you to the appropriate resources. Treatment can involve medical supervision, individual or group therapy, peer support, 12 step recovery, case management, family therapy, and psychiatric services.

Below are several links depending on your need:

• Contact MI 2-1-1: Help is available 24/7. This is accessible via phone, live chat, text, or by searching online.
• Michigan’s Opioid Treatment Directory (SAMHSA)
• Find a Narcotics Anonymous (NA) Meeting in your area
• Find an Alcoholic Anonymous (AA) Meeting in your area
• Brain Injury Association of Michigan (BIAMI)

If any of these apply to someone you know, show that person that you care, are concerned, and are there to support them! Understand that there are likely reasons they do what they do:

• Self-medicate for severe/chronic pain from their injuries
• Cope with the trauma that they have endured
• Try to combat their symptoms of depression due to a loss they have experienced in their life
• Escape from their new reality
• Use due to an underlying mental health condition

You can use the resources above, or contact a professional who can help you get connected. You can also contact the BIAMI staff to help you connect with helpful resources. Stay strong, supportive, and realize that they may be doing the best they can, in this moment, to get through whatever difficulties they may be facing.

Angela M. Haas, LMSW CAADC is a licensed master’s level social worker with her certified advanced alcohol and drug counselor certification. She works with Special Tree Rehabilitation Systems in their outpatient clinic in Midland and Saginaw.