The Development and Management of Post traumatic Epilepsy
Post traumatic epilepsy (PTE) is a significant health burden on patients who suffer traumatic brain injury (TBI), which is observable and may be preventable. PTE is often treatment resistant, and associated with significant morbidity and mortality. Investigation of epileptogenesis, the development of epilepsy, presents an opportunity for intervention prior to the development of PTE. This study will take advantage of a major NIH funded international, multicentre, study of epileptogenesis post TBI (EpiBioS4Rx) to investigate biomarkers associated with acute symptomatic seizures and PTE. Using international and local databases from trauma services and epilepsy monitoring units, this study aims to identify clinical, diagnostic and management factors associated with PTE. Preclinical biochemical, imaging and electrophysiological data suggests candidate biomarkers of epileptogensis for further evaluation in humans. Patients with moderate-severe TBI require intensive care therapy in hospital and represent an ideal patient group that may be investigated. Acute seizures may be detected by continuous EEG monitoring in the ICU which are largely non-convulsive and subclinical, currently performed in centres overseas, and have been associated with deleterious metabolic changes. Neuromonitoring via continuous EEG has yet to be utilised in Australia and has potential to detect seizures and aid at the bedside. Continuous EEG monitoring will be performed in all patients recruited to evaluate for seizures and associated EEG biomarkers, and correlate these findings with other clinical and investigational biomarkers of PTE. Treating seizures detected by continuous EEG will be reviewed for its effects on overall outcomes, and effect on epileptogenesis as a disease modifying therapy. Overall, this study aims to observe epileptogenesis in humans and assess biomarkers contributing to the development of PTE, with a view to informing novel disease modifying and curative therapies that may be transferable across other forms of epilepsy.