Reevaluating the Treatment of Epilepsy
Juliann Paolicchi, MD, a neurologist and member of the epilepsy team at Northwell Health in New York, who was not involved with the study, said in an interview that TBIs have been studied more closely since the beginning of conflicts in the Middle East, particularly in Iran and Afghanistan, where “newer artillery causes more diffuse traumatic injury to the brain and the body than the effects of more typical weaponry.”
Northwell Health
Dr. Juliann Paolicchi
The study by Roghani and colleagues, she said, “is groundbreaking in that it looks at the connection and timing of these two disruptive forces, epilepsy and TBI, on the brain,” she said. “The study reveals that timing is everything: The combination of two disrupting circuitry effects in proximity can have a deadly effect. The summation is greater than either alone in veterans, and has significant effects on the brain’s ability to sustain the functions that keep us alive.”
The 6 months following either a diagnosis of epilepsy or TBI is “crucial,” Dr. Paolicchi noted. “Military and private citizens should be closely monitored during this period, and the results suggest they should refrain from activities that could predispose to further brain injury.”
In addition, current standards for treatment of epilepsy may need to be reevaluated, she said. “Patients are not always treated with a seizure medication after a first seizure, but perhaps, especially in patients at higher risk for brain injury such as the military and athletes, that policy warrants further examination.”
The findings by Roghani and colleagues may also extend to other groups, such as evaluating athletes after a concussion, patients after they are in a motor vehicle accident, and infants with traumatic brain injury, Dr. Paolicchi said. “The results suggest a reexamining of the proximity [of TBI] and epilepsy in these and other areas,” she noted.
The authors reported personal and institutional relationships in the form of research support and other financial compensation from AbbVie, Biohaven, CURE, Department of Defense, Department of Veterans Affairs (VA), Eisai, Engage, National Institutes of Health, Sanofi, SCS Consulting, Sunovion, and UCB. This study was supported by funding from the Department of Defense, VA Health Systems, and the VA HSR&D Informatics, Decision Enhancement, and Analytic Sciences Center of Innovation. Dr. Paolicchi reports no relevant conflicts of interest.
