With Some Forms of Traumatic Brain Injury, Non-Deployed Veterans Have Higher Risk of Epilepsy than Deployed Veterans
BACKGROUND:
Traumatic brain injury (TBI) is a known epilepsy risk factor and is common among Veterans. Because deployment raises the risk of blast or combat exposure that can cause TBI, some researchers have hypothesized that deployment would be associated with a higher incidence of epilepsy. In this study, researchers reviewed the medical records of 938,890 post-9/11 Veterans (average age of 35) with two or more years of care in VA and DoD health systems to examine associations of all TBI exposures and epilepsy among Veterans by deployment history. Of the total participants, 71% had been deployed and 3% had epilepsy. The researchers adjusted for comorbidities (e.g., brain tumor, depression, bipolar disorder, dementia) associated with epilepsy.
FINDINGS:
- Epilepsy was more common among non-deployed Veterans than among deployed Veterans (4% vs. 3%).
- Epilepsy risk for Veterans with moderate or severe TBI was significantly higher among those who had never been deployed than among those who had been deployed, possibly because good health is required for deployment (the “healthy warrior effect”).
- Epilepsy risk for Veterans with mild TBI did not differ by deployment history.
- Epilepsy risk for Veterans with penetrating TBI—the most severe form of TBI—was higher for deployed Veterans than non-deployed Veterans.
- TBI was a significant predictor of epilepsy regardless of Veterans’ deployment status, and the odds of epilepsy increased with TBI severity.
IMPLICATIONS:
- Closer monitoring for epilepsy among Veterans with epilepsy risk factors might shorten the time to diagnosis and treatment.
- A better understanding of deployment effects is critical to provide targeted epilepsy prevention in Veterans and military service members.
- Since most TBI occurs in non-deployed settings, understanding TBI in these settings is also critical to focused approaches to epilepsy prevention in Veterans and military service members.
LIMITATIONS:
- Results might not be generalizable to other Veteran groups, such as older Veterans, due to their differing war exposures.
- The study might under- or overestimate the prevalence of epilepsy in post-9/11 Veterans because it represents care received only inside the VA and DoD systems.
AUTHOR/FUNDING INFORMATION:
This study was partially funded by HSR&D. Dr. Pugh was supported by an HSR&D Research Career Scientist Award. Drs. Kennedy, Panahi, and Pugh, with Mss. Henion and Amuan, are part of HSR&D’s Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) in Salt Lake City, UT.
Henion A, Wang C-P, Amuan M, et al. The Role of Deployment History on the Association between Epilepsy and Traumatic Brain Injury in Post-9/11 Era U.S. Veterans. Neurology. November 29, 2023;online ahead of print.
