Post traumatic epilepsy （PTE） refers to the epileptic seizures after traumatic brain injury. Organic damage can be found by imaging examination, and abnormal electroencephalogram can be detected via electroencephalogram examination which has the similar location of the brain injury. PTE has the characteristics of low incidence, absence of case reports, and easy to exaggerate the state of illness, which add difficulties to the forensic identification. This paper reviews the status of epidemiology, pathogenesis, clinical treatment and forensic identification for PTE.
Brain Injuries, Traumatic/physiopathology* ; Electroencephalography ; Epilepsy ; Epilepsy, Post-Traumatic/pathology* ; Forensic Pathology ; Humans ; Incidence

Post traumatic epilepsy （PTE） is a serious complication of traumatic brain injury and a difficult problem in forensic justice practice. In recent years, many biomarkers have been applied to the diagnosis, treatment and prognosis of injuries and diseases. There have been many studies on the biomarkers of PTE in the field of epilepsy. This paper reviews the progress in research on biomarkers of PTE in recent years in order to provide reference for the forensic identification of PTE.
Biomarkers/analysis* ; Brain Injuries, Traumatic/diagnosis* ; Epilepsy/etiology* ; Epilepsy, Post-Traumatic/etiology* ; Humans

Posttraumatic headache (PTH) is one of several complications of traumatic brain injury (TBI). PTH usually resolving within the first 3 months, although a minority develop chronic headaches. PTH remains among the most controversial headache topics to its propensity for chronicity and often associated additional cognitive, behavioral, and somatic problems. Sufficient psychological or neurobiological markers for PTH do no exist, thus treatment can be very challenging and should always be multidisciplinary to make every reasonable effort in preventing the development of chronic pain. Posttraumatic seizure or epilepsy (PTE) is defined as a recurrent seizure disorder due to traumatic brain injury. PTE can be divided into three groups: immediate, early and late seizures. Immediate and early seizures are provoked seizures, whereas late seizure is unprovoked seizure. The effects of antiepileptic drugs (AED) in patients with TBI must be assessed separately in terms of prevention and control of provoked seizures and prevention of subsequent unprovoked seizures. Routine preventive AEDs are not indicated for patients with TBI and the effects are controversy.
Anticonvulsants ; Brain ; Brain Injuries ; Chronic Pain ; Epilepsy ; Headache ; Headache Disorders ; Humans ; Post-Traumatic Headache ; Seizures

Most people presume that the life expectancy of disbled persons after head injury may be shorter than that of the general population. Except for a few specific situations, such as the persistent vegetative state or in patients with a traumatic epilepsy, there are no firm medical evidences to support such a presumption. Furthermore, there are no available guidelines or data for proper estimation of the length of survival for such patients. Estimation based on the limited data or personal experience may cause considerable discrepancies among doctors. The author had reviewed literatures on the life expectancy of disabled or head injured persons, and proposed a scheme or estimation of the life expectancy of disabled persons after head injury. Age and sex of the disabled person, and everity of the disability were used as factors determining the lifespan. This proposal can be a useful reference to estimate the life expectancy of disabled persons after head injury, which will reduce the discrepancy derived from doctors' personal experiences.
Craniocerebral Trauma* ; Disabled Persons* ; Epilepsy, Post-Traumatic ; Head* ; Humans ; Life Expectancy* ; Persistent Vegetative State

OBJECTIVETo observe the quality of life in patients with post-traumatic epilepsy and discuss the influencing factors.

METHODSWe assessed 105 patients with post-traumatic epilepsy and 100 healthy people as control using Quality of Life Scale-31 (QOL-31), Self-rating Depressing Scale (SDS) and Self-rating Anxiety Scale (SAS), and conducted retrospective analysis on the depression, anxiety, site of trauma, control of seizure, EEG and therapeutic compliance.

RESULTSPatients with post-traumatic epilepsy scored much lower than the control group on QOL-31 (P less than 0.01), but higher than the control group on SDS and SAS (P less than 0.01). Multiple regression analysis indicated that major influencing factors on the quality of life were anxiety, therapeutic compliance, depression, poor control of epileptic seizure and site of trauma.

CONCLUSIONSThe quality of life in patients with post-traumatic epilepsy has significantly declined. Doctors should pay attention to psychological and mental problems of patients with epilepsy, such as depression and anxiety, enhancing therapeutic compliance and controlling epileptic seizure, which are the keys to improving prognosis.

UNLABELLED: To evaluate the forensic determination of post cerebral traumatic epilepsy. METHODS: In 21 patients, traumatic history and previous history were analysied combined with the demonstrations of electroencephalogram(EEG), X-ray, CT and MRI. RESULTS: Post-traumatic epilepsy, manily in late stage, usually occurred following serious cerebral trauma. The type of traumatic epilepsy was determined by the traumatic location and extent. Abnormal epileptic wave in scalp EEG and 24 h dynamic EEG and medical image examinations were helpful for qualitative analysis. CONCLUSION The forensic determination of post traumatic epilepsy must be on the basis of traumatic and previous history combined with EEG, CT and MRI analysis.
Adult ; Brain Injuries/complications* ; Epilepsy, Post-Traumatic/etiology* ; Female ; Forensic Medicine ; Humans ; Male ; Middle Aged

Objective To summarize the general characteristics and identification considerations of appraisal of post-traumatic epilepsy （PTE） in forensic clinical expertise. Methods Descriptive statistics were made on the general situations （age and sex）, injury sites, PTE grading, clinical manifestations and blood drug concentrations of 30 cases of PTE. Chi-square test was performed on the differences of sex composition, age group incidences, injury sites, clinical manifestations and PTE grading. Fisher's exact probability method was used to test the differences in clinical manifestations and PTE grading of each site and the differences in PTE grading of different clinical manifestations. Results PTE occurred more frequently among 21 to 40 year olds, more in males than in females, and more frequently in the temporal lobe and frontal lobe. The clinical manifestations were mostly partial seizures and the PTE grading was mostly mild PTE. There were no statistical significance in the differences in distribution of clinical manifestations and PTE grading of injury sites （P>0.05）. The difference in the PTE grading of different clinical manifestations had no statistical significance （P>0.05）. The blood drug concentration of the three identified people did not reach the effective concentration, which affected the final identification opinion. Conclusion In the identification of PTE, in addition to strictly grasping the necessary factors of identification, such as the history of craniocerebral trauma, and epileptic seizures, it is also suggested that attention should be paid to the detection of blood drug concentration. Overall analysis and comprehensive evaluation should be made.
Adult ; Craniocerebral Trauma ; Epilepsy, Post-Traumatic ; Female ; Humans ; Incidence ; Male ; Retrospective Studies ; Young Adult

OBJECTIVE: Vagus nerve stimulation (VNS) has been used in epilepsy patients refractory to standard medical treatments and unsuitable candidates for resective or disconnective surgery. In this study, we investigated the efficacy of VNS to patients who had refractory result to epilepsy surgery and patients with post-traumatic epilepsy. METHODS: We analyzed the effect of VNS in 11 patients who had undergone previous epilepsy surgery and patients with intractable post-traumatic epilepsy associated with brain injury. All patients underwent VNS implantation between October 2005 and December 2006. RESULTS: We evaluated seizure frequency before and after implantation of VNS and maximum follow up period was 24 months. In the first 6 months, 11 patients showed an average of 74.3% seizure reduction. After 12 months, 10 patients showed 85.2% seizure reduction. Eighteen months after implantation, 9 patients showed 92.4% seizure reduction and 7 patients showed 97.2% seizure reduction after 24 months. Six patients were seizure-free at this time. CONCLUSION: We conclude that the VNS is a helpful treatment modality in patients with surgically refractory epilepsy and in patients with post-traumatic epilepsy due to severe brain injury.
Brain Injuries ; Electric Stimulation ; Epilepsy ; Epilepsy, Post-Traumatic ; Follow-Up Studies ; Humans ; Seizures ; Vagus Nerve ; Vagus Nerve Stimulation

For ictogenesis, initial step is intrinsic bursts of pacemaker neurons and, through exaggerated circuits or networks, the involved neurons become hyperexcitable state. Hypersynchrony of hyperexcitable neurons can induce paroxysmal depolarization shift for developing seizure. The mechanism underlying the development of post-traumatic epilepsy still remains to be elucidated. By traumatic brain injury, breakdown of blood-brain barrier (BBB) may lead network changes, long-lasting epileptiform activity and eventual neurodegeneration. Recently the concept of inflammation and epileptogenesis is widely accepted. In the surgically resected brain tissue from refractory partial epilepsy patients, there are hallmarks of a chronic inflammatory state and, also, via animal experiments, we can find the role of inflammation in the genesis of seizure and epilepsy. Inflammatory mediators (IL-1b, TGF-beta1 and COX-2) are associated with the epileptogenic brain. They can reduce seizure threshold, induce neurodegeneration, neurogenesis, and synaptic plasticity, and also disregulate BBB permeability. The increase in knowledge about a role of inflammation in epileptogenesis may support the use of specific anti-inflammatory drugs for developing disease-modifying treatments that can interfere epileptogenesis.
Animal Experimentation ; Blood-Brain Barrier ; Brain ; Brain Injuries ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Post-Traumatic ; Humans ; Inflammation ; Neurogenesis ; Neurons ; Permeability ; Plastics ; Seizures ; Transforming Growth Factor beta1

Post-traumatic seizure is a known consequence of head trauma and a major public problem. But the surveillance study of this problem in our country is very rate. The purpose of the current study was to determine the incidence, clinical patterns and the outcome of the post-traumatic seizure in our institute. A retrospective review of management in 5053 patients with head injury was performed in our department between 1983 and 1992. In our series, the frequency of post-traumatic epilepsy was 254 patients, giving 1 5.0% incidence rate(early seizure occurred in 2.2% and late seizure occurred in 2.8% of patients). Of these, the records of 203 patients who received follow-up care for at least 2 years was reviewed. The first early epileptic attack occurred within 24 hours of injury in one third of the cases(33.3%), and the first late epileptic attack occurred within 1 year was about two thirds of the cases(64.6%). On CT scan findings, the early epilepsy had a higher incidence in scans that showed diffuse brain swelli ng and the late epilepsy had a higher incidence in subdural and intracerebral hematoma. 57.5% of early seizure were focal type, and 55.2% of late seizure were generalized convulsive seizure. The outcome of severe head injury patients with early seizure was better than that of late seizure group. The severity of head injury was related to the occurrence of late post-traumatic seizure.Development of new antiepileptic drugs, increasing knowledge of preventing post-traumatic sequelae and demand for surgical treatments have allowed the reduction of the incidence of the post-traumatic seizures. But further survey or study is recommanded in order to achieve more improvement in the management of post-traumatic seizures.
Anticonvulsants ; Brain ; Craniocerebral Trauma* ; Electroencephalography ; Epilepsy ; Epilepsy, Post-Traumatic ; Follow-Up Studies ; Head* ; Hematoma ; Humans ; Incidence* ; Retrospective Studies ; Seizures* ; Tomography, X-Ray Computed