A new study published in the journal Neurology has shown a high prevalence of other health conditions like depression, post-traumatic stress disorder (PTSD), back pain and headache in people with epilepsy associated with traumatic brain injury, which may reduce their quality of life (QoL).^1,2  

 This study investigated the impact of drug resistance, traumatic brain injury and comorbidity on QoL in 529 post-9/11 veterans with epilepsy. Four phenotypes of epilepsy were defined; 124 had drug resistant epilepsy; 86 had post-traumatic epilepsy, while 70 had drug resistant post-traumatic epilepsy (PT-DRE). Epilepsy was controlled with medications in 249 subjects i.e., it was neither drug resistant nor associated with traumatic brain injury; this group acted as controls. The six QoL measures were compared across all the four groups after adjusting for age, sex and comorbid conditions.  

Analysis of data revealed that 45% of patients with post-traumatic epilepsy were more likely to also have drug-resistant epilepsy compared to 33% of those with non-traumatic epilepsy with an odds ratio of 1.6. Comorbid conditions such as depression, post-traumatic stress disorder (PTSD), back pain, anxiety, sleep disorders, headache were more common in patients with post-traumatic epilepsy and drug resistant post-traumatic epilepsy. These were also the patients who had the lowest QoL across all six measures even after adjusting for the presence of comorbidities. Their QoL score was 21.2 versus a score of 35.5 in the control group.

Epilepsy associated with traumatic brain injury is more likely to be resistant to anti-epileptic drugs compared to epilepsy that is non-traumatic in origin, which affects their quality of life. The prevalence of conditions like depression, anxiety, sleep disorders was also higher in patients with post-traumatic epilepsy, which further augmented the poor QoL and also adversely affected life expectancy. But, being an observational study, these findings only show an association between epilepsy due to traumatic brain injuries and drug resistant epilepsy and poor quality of life and “does not prove that people with drug resistant epilepsy associated with head injury will have poorer quality of life”. Patients with post-traumatic drug resistant epilepsy should be the subjects for further studies to find measures to improve their QoL.

References

1. Gugger JJ, et al. Multimodal quality of life assessment in post-9/11 veterans with epilepsy: impact of drug resistance, traumatic brain injury, and comorbidity. Neurology. 2022 Apr 6;10.1212/WNL.0000000000200146. doi: 10.1212/WNL.0000000000200146.
2. AAN Press release, April 6, 2022. https://www.aan.com/PressRoom/Home/PressRelease/4978.