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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1072 — The Nexus of Traumatic Brain Injury and Epilepsy in OEF/OIF Veterans

Amuan ME, CHQOER; Pugh MJ, VERDICT;

Objectives:
Traumatic Brain Injury (TBI) is considered the signature wound of the wars in Afghanistan and Iraq (OEF/OIF/OND) due to the proliferation of weapons such as improvised explosive devices. We examined the relationship between TBI and epilepsy in OEF/OIF/OND Veterans since TBI is the primary cause of new-onset epilepsy in young adults, and VA has invested substantial resources in Epilepsy Centers of Excellence (ECOE) due to a hypothesized increase in epilepsy among this cohort.

Methods:
We used VA Decision Support System data (inpatient, outpatient, pharmacy) to identify OEF/OIF/OND Veterans receiving VA care in FY08-09. We then identified individuals meeting the criteria for epilepsy using a previously validated algorithm (ICD-9-CM codes 780.3 or 345 and antiepileptic drug treatment). We identified comorbidities associated with epilepsy in prior studies, including TBI and other indications of blast injury (e.g., visual/auditory problems, burns, spinal cord injury), and chronic diseases (Selim comorbidity indices) using previously validated algorithms. Logistic regression models examined the relationship between TBI and prevalent epilepsy, controlling for chronic disease and demographic characteristics.

Results:
Of 191,797 individuals meeting inclusion criteria, 1,225 (0.64%) met criteria for epilepsy. Individuals with mild TBI (concussion; OR 2.04, [1.75-2.38]) and moderate/severe TBI (OR 6.93, [3.37-14.25]) had increased likelihood of epilepsy. Other variables consistent with TBI were also associated with increased likelihood of epilepsy: spinal cord injury (OR 6.05 [4.15-8.82]), headache (OR 2.0641 [2.12-2.74]), inner-ear problems (OR 1.76 [1.54-2.13]), and visual disturbances (OR 2.13 [1.68-2.70]). Younger Veterans (20-28 years), who are more commonly in active combat, comprised 40.7% of epilepsy cases; those >= 45 years were at reduced likelihood of epilepsy (OR 0.58 [0.47-0.70]).

Implications:
The influx of OEF/OIF/OND Veterans with mild to severe TBI has been associated with increased prevalence of epilepsy compared to similarly aged adults, and similarly aged Veterans in FY99. This increase is attributed primarily to TBI, including mild TBI.

Impacts:
These data suggest the theoretical increase in epilepsy among OEF/OIF/OND Veterans is being realized. In order to assure the highest quality of care to this population, research is needed to examine the implementation of the ECOEs and the effect of VA’s reorganization of epilepsy care, and identify targets for implementation to improve the quality of epilepsy care.


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