Seizure Disorder and Brain Injury

November is Epilepsy Awareness Month, a time of the year to help promote awareness and educate the general public about epilepsy and seizures. One of the common challenges seen with brain injury is seizure disorder – more commonly known as epilepsy. Epilepsy and seizure disorder are terms often used interchangeably, but there are distinct differences. Seizures are the individual events of a sudden loss of control of functions associated with normal brain activity. They are sudden, temporary episodes of brain dysfunction, caused by the abrupt, non-purposeful discharge of electrical activity in the brain. Typically lasting 1-5 minutes, they are characterized by changes in sensation, emotional experience, motor control, and levels of consciousness.
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: Martin J. Waalkes, Ph.D., ABPP(rp), CBIS-T
Licensed Psychologist
Director of Neuro Rehabilitation
Hope Network Neuro Rehabilitation

TBI Survivors and Addiction Risk

Pictured above: Angela Haas, author of blog post

You have likely dealt with substance abuse before, whether it’s in your family, a friend of a friend, or someone you are working with now. If so, you know that substance abuse has an effect on everyone, but that effect is especially dangerous for those who have suffered a traumatic brain injury.

For brain injury survivors, alcohol and drugs can increase the likelihood of seizures, and can also have dangerous interactions with individuals’ prescribed medications. In addition, alcohol and drugs affect our brains differently, and can have a much more powerful effect on someone with a brain injury.

Just as importantly, alcohol and drug use may increase the likelihood of re-injury, as survivors under the influence are more likely to engage in behaviors such as impaired driving, or suffer difficulties with balance or impulsive decision making.

Some of the most bothersome cognitive impacts of TBI include issues with decision-making (mentioned above), as well as problem solving, short-term memory, low inhibition, and decreased awareness. Alcohol and drugs can exacerbate all of these symptoms, unquestionably impacting recovery -- which is why complete abstinence from alcohol and drugs is the healthiest and safest choice to aid in brain injury recovery and sustainability.

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:

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.

A Response to the Recent CTE Study

Written by Or, Sean Rose

A newly published research study, titled “Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football’” diagnosed CTE in 110 of 111 former NFL players, and overall in 177 of 202 former football players with varying amounts of playing exposure. This is an important study because it included the largest number of CTE cases in football players ever published. However, it’s important to put these results into the right context.

Understanding two different research principles is necessary when interpreting the results: levels of scientific evidence and selection bias. There are multiple levels of scientific evidence, from weak to strong. Opinion and anecdotal findings (for example, when a doctor notices a pattern in a few of his/her patients) are the weakest types of evidence. Randomized trials and compilations of multiple trials are the strongest. A case series: which means that the people included in the study were chosen based on their medical condition, is considered to be one of the weaker types of This study is a case series because the football players were already known or suspected to have CTE. Case series are unable to establish a cause-effect relationship or the incidence of a disease.

“Selection bias” means that the people who are included in a study are not randomly chosen, and the group chosen is not representative of the population that needs to be studied. For example, if you want to know what percentage of students at a school have strep throat, you would bias the results by only testing those students complaining of a sore throat. In this study, the player or his family chose to donate his brain to be studied for CTE, likely because he was having symptoms and other brain problems before he died. Farmer football players who do not have symptoms before dying are less likely to donate their brains to be studied for CTE.

Keeping in mind these two research principles, it becomes clear that focusing on the percentage of football players diagnosed with CTE in this study is misleading. The high frequency of CTE in this group of patients could represent the high degree of selection bias. As the authors of this study acknowledge, “Caution must be used in interpreting the high frequency of CTE in this sample, and estimates of prevalence cannot be concluded or implied from this sample.” Much more research, involving study types with stronger scientific evidence, is needed to determine the risk factors for developing CTE. Studying a random group of former football players’ brains, or following a group of youth football players through their years of participation, would provide that stronger evidence.

As we await the results of ongoing research in these areas, we should be thoughtful in the way we handle the current evidence. CTE does develop in some football players, as well as other athletes and non-athletes who are exposed to repetitive head impacts. We don’t know the degree of risk, but it is reasonable to assume that there is a dose effect (i.e. more head impacts increase your risk). Taking results from studies of NFL players and applying them to children is problematic. In the current study, CTE was not seen in any individuals who only played football in grade school, and seen at a low frequency in those who only played through high school. It is also important to note that the current study findings have not been replicated in better designed studies. For example, in a study of over 400 individuals (average age 68) who played high school football from 1946-1956, there was no increased risk of dementia or other neurodegenerative diseases compared to classmates who did not play a contact sport.1

The bottom line is that while concern about CTE in former NFL players may be an appropriate response to this study, putting it into the right context highlights the need to conduct substantially more research using different stud y designs before we make dramatic conclusions and statements about CTE and contact sports participation in general.

1. Savica R, Parisi JE, Wold LE, Josephs KA, Ahlskog JE. High school football and risk of neurodegeneration a community-based study. Mayo Clinic Proc. 2012;87:335-340.

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