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2019 HSR&D/QUERI National Conference Abstract

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4119 — Epilepsy in the context of TBI: Is epilepsy specialty care enough?

Lead/Presenter: Anne Van Cott,  Pittsburgh VA Medical Center
All Authors: VanCott AC (VA Pittsburgh Health Care System), Altalib HH, PRIME COIN, West Haven Diaz-Arrastia R, University of Pennsylvania, Philadelphia Kean J, IDEAS COIN, Salt Lake City Padilla SM, IDEAS COIN, Salt Lake City Pugh MJ, IDEAS COIN, Salt Lake City

Objectives:
The Department of Veterans Affairs (VA) has established the Polytrauma system of care and Epilepsy Centers of Excellence (ECOE) to address the needs of Post-9/11 Veterans with traumatic brain injury (TBI) and TBI/polytrauma sequelae such as epilepsy, which is more common among Veterans with TBI, including mild TBI (mTBI). Because little is known about the impact of post-traumatic epilepsy in young adults, we examined the complex relationship among neurobehavioral symptomology, epilepsy, TBI severity, and blast-related exposures.

Methods:
From our cohort of Post-9/11 Veterans, we identified those who met epilepsy criteria based our validated algorithm, and validated cases by chart abstraction. We obtained comprehensive TBI evaluation (CTBIE) data for those with and without epilepsy, then compared affective, cognitive, somatic and vestibular scale scores of the Neurobehavioral Symptom Inventory by epilepsy and TBI/Blast status (e.g., mTBI+/-blast; mod-severe TBI+/-blast). Adjusted analyses controlled for demographic characteristics and mental health comorbidity.

Results:
Among the 102,937 Veterans with CTBIE data, there were 100,553 without epilepsy and 2384 epilepsy cases. The majority of VWE had mTBI with blast exposure (n = 1375) followed by moderate/severe TBI with blast exposure (n = 476). VWE were also significantly more likely to have moderate/severe TBI with/without blast exposure, and higher prevalence of all mental health conditions. VWE reported significantly higher symptomology on all scales than their counterparts without epilepsy (e.g., cognitive mean: epilepsy+mTBI+blast = 2.52 (SD = 0.99); no epilepsy+mTBI+blast = 2.02 (SD = 1.05)). Among VWE, those with blast exposure reported higher symptomology than those without blast exposure (e.g., affective mean: epilepsy+mTBI+blast = 2.77 (SD = 0.90); epilepsy+mTBI = 2.54 (SD = .97); p < .05). The effect of blast exposure was consistent across subscales and epilepsy severity and TBI strata. Similar findings were obtained after adjusting for mental health comorbidity.

Implications:
Epilepsy conferred significant symptom burden, especially in cognitive and affective domains, above and beyond TBI/blast exposure.

Impacts:
Closer evaluation of epilepsy care models is needed as epilepsy prevalence increases in Post-9/11 Veterans with TBI. For VWE, epilepsy is generally treated within the ECOE structure that does not systematically integrate mental health/neuropsychology into the treatment team. VWE with TBI/blast history may benefit from a stronger collaboration/referral system between ECOE and polytrauma system of care to assess and address symptomology associated with TBI/blast exposure.