Post-traumatic epilepsy (PTE) is a seizure disorder that occurs when the brain experiences damage from physical trauma. Close monitoring by a medical team and using prescription medication can help manage this condition.

Epilepsy is a chronic neurological disorder that causes recurring seizures. Head trauma that leads to a brain injury can cause PTE. Approximately 1.7 million traumatic brain injuries occur annually in the United States.

However, PTE accounts for less than 1 in 10 epilepsy cases, according to an older 2015 review of studies, so experiencing head trauma does not guarantee a person will develop PTE.

This article takes a closer look at PTE, including its symptoms, causes, risk factors, diagnosis, treatment, and outlook.

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Recurrent seizures that occur within 7 days after a traumatic brain injury are a primary symptom of PTE.

The Epilepsy Foundation suggests that 1 in 10 people experience a seizure in the first 7 days following a traumatic brain injury, putting them at higher risk of developing PTE.

Symptoms of PTE seizures can include:

  • stiffening of the legs, arms, or neck
  • shaking of the body
  • unresponsiveness and staring into space
  • having a strange feeling
  • inability to speak coherently
  • confusion

Some people with traumatic brain injuries may develop recurrent seizures months or years later. An older 2016 article suggests late seizures like this may indicate a permanent change in brain structures due to brain rewiring or nervous system impairment.

A traumatic head injury can occur during events such as vehicle collisions, a severe blow to the head during sports, or when objects pierce the skull, such as bullets from gunshot wounds.

Traumatic head injuries can cause changes to the brain, which may lead to seizures and PTE. According to The Epilepsy Foundation, these changes are still under investigation. However, they may include:

  • intracranial hemorrhage — bleeding inside the brain
  • edema — swelling of the brain
  • cerebral contusion — brain tissue bruises that cause scattered bleeding on the surfaces of the brain
  • ischemia — not enough blood flow to the brain tissue
  • scarring in brain tissue resulting from penetrating brain injuries
  • chemical changes that alter the function of certain brain cells

Some groups of people are at higher risk of experiencing a traumatic brain injury. This includes military personnel, service members, and professional athletes.

The Epilepsy Foundation suggests that people are at higher risk of developing PTE if they experience:

  • seizures within 7 days of traumatic brain injury
  • bleeding or bruising of the brain when injured
  • a penetrating brain injury
  • a head injury that relates to alcohol consumption
  • skull fractures that cause bone to penetrate the brain
  • depressed skull fractures that cause brain compression

It also suggests that people over the age of 65 and people with a family history of epilepsy may be at higher risk of developing PTE after a traumatic brain injury.

Notably, the greater the severity of a brain injury, the higher its risk of causing PTE.

Some people may experience a seizure within 7 days after a brain injury. Others may experience a late seizure that occurs more than 7 days after a brain injury.

According to an older 2014 article, doctors can use a late seizure in their diagnosis of PTE since the risk of recurrence is about 80%.

Some of the standard tests healthcare professionals use for PTE diagnosis include:

  • Electroencephalography (EEG): This test uses small metal discs — electrodes — to measure electrical activity in the brain. It can detect abnormalities in brain cells and brain waves.
  • Computed tomography (CT) scan: This type of X-ray creates detailed images of the brain and can help a doctor assess areas of brain injury after a moderate-to-severe traumatic brain injury.
  • Magnetic resonance imaging (MRI) scan: An MRI scan can help a doctor understand what is causing a seizure. It can help detect changes in brain structure and help evaluate the effectiveness of a treatment approach for PTE.

Doctors may prescribe antiseizure medication as a first step because controlling seizures quickly can lower the risk of further injury to the brain.

If a person experiences late seizures following a traumatic brain injury, doctors may prescribe long-term anticonvulsant treatment.

However, the specific medication they prescribe will usually depend on the type of seizure a person experiences and their medical history.

A 2017 review mentions using prophylactic medications, such as phenytoin, to prevent seizures within the first 7 days following a traumatic brain injury. However, it concludes that further research is necessary to determine the efficacy of these medications.

If people continue to experience PTE seizures after taking antiseizure medications, a doctor may consider treatments including:

  • Surgery: Doctors may attempt to remove epileptogenic brain tissue in suitable candidates.
  • Vagus nerve stimulation therapy: This sends small electrical pulses into the brain via the vagus nerve to prevent or lessen seizures.
  • Responsive neurostimulation (RNS) therapy: This uses a device to monitor brain waves and detect unusual activity that may indicate a seizure. It provides stimulation to reset these brain waves and prevent a seizure.
  • Deep brain stimulation therapy: This is a device doctors use alongside seizure medication. It uses electrical stimulation to alter brain cells and networks to control seizures.

A 2022 cohort study suggests that people with epilepsy have a reduced life expectancy compared with the general population.

A 2021 article suggests that this may be due to:

  • sudden unexpected death in epilepsy (SUDEP)
  • accidents, such as falls or drowning
  • mental health conditions, such as depression

Additionally, treating PTE can be challenging. Treatment focuses on managing seizures, but not all treatments work for everyone.

However, The Epilepsy Foundation states that epilepsy does not shorten life expectancy in most cases.

A person can work with healthcare professionals to create a treatment plan that is best suited to manage their symptoms and seizures.

Learn more about the risks relating to seizures and epilepsy here.

Here are some of the most frequently asked questions about PTE.

Can emotional trauma cause epilepsy?

Emotional trauma, which can stem from factors such as stress and depression, may increase the risk of developing epilepsy.

Acute stress due to traumatic events can trigger epilepsy in some people. A 2021 observational study indicates that adverse life events and early-life stress can also increase the risk of epilepsy.

Does post-traumatic epilepsy go away?

Some people with PTE may have a silent or latent period of up to 20 years. During this period, they won’t experience seizures.

Also, an older article by The Epilepsy Foundation states that about half of people who develop PTE years after a traumatic brain injury will have spontaneous remission. This may be temporary or permanent.

Can a person prevent post-traumatic epilepsy?

According to the World Health Organization (WHO), around 25 in 100 epilepsy cases are preventable. In the case of PTE, the best way to prevent it is to protect the head from injuries by:

  • reducing the risk of falls
  • driving carefully to avoid car accidents
  • using a seatbelt when driving
  • wearing any appropriate protective headgear at work to prevent occupational hazards
  • protecting the head during sports to avoid injuries

PTE is a chronic neurological condition that can reduce a person’s quality of life. It presents with recurrent seizures that often start within 7 days following a traumatic brain injury. However, in some people, the seizures may start months or even years later.

Seeking medical attention after a trauma to the brain can help prevent seizures, at least in the initial stage. Some people may also find that their PTE goes into remission in the later stages.