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Post-Traumatic Epilepsy: Cognitive and Neuro-Behavioral Characteristics among Post-9/11 United States war Veterans (PTE-CNBC)

Led by Post-Doc Jamie Mayo, PhD, RN

Post-traumatic epilepsy (PTE) refers to epilepsy that develops after a traumatic brain injury (TBI). The Department of Defense (DoD) in 2013 reported that 8% of the active duty service members diagnosed with new onset epilepsy have a previously diagnosed TBI.

This is a significant concern for the DoD and Department of Veterans Affairs (VA) because a high number of Post-9/11 service members have suffered a TBI while deployed. A previous study by Pugh, in 2015 examined the association between TBI and epilepsy in Post-9/11 Veterans. Findings showed that even individuals with mild TBI (mTBI) were highly likely to be diagnosed and treated for epilepsy compared to Veterans without TBI. PTE after TBI may act as a “Second Hit” on a brain that is already vulnerable to the development of various neurological deficits and disabilities due to TBI. This can accelerate their cognitive and behavioral ageing. This may profoundly affect the lives of these young Veterans, their families, and the healthcare systems on which they depend for care.

Previous reports suggest that PTE may negatively influence the functional and behavioral outcome of patients with severe TBI. However, there are very few civilian and no Veteran studies that have examined this association among those with mTBI. Distinguishing healthy cognitive and behavioral ageing from accelerated decline has important impacts on diagnosis and treatment. Combining neuropsychological and neuroimaging data with the demographic and clinical data can improve our ability to identify subgroups with distinct cognitive and behavioral symptoms. This can also aid in better understanding of the relationship between epilepsy and cognitive and behavioral impairments.

In this study, we will identify Veterans with new onset epilepsy after mTBI and those with only mTBI or epilepsy. Then we will review their clinical documents such as clinician notes, test records, and imaging reports. We will identify various symptoms related to cognition such as memory, learning, understanding, and reasoning. We will also identify symptoms related to behavior such as aggression, irritability, depressive mood, and personality disorders. We will then describe how often these symptoms occur in the study groups and also describe the patterns (neurobehavioral phenotypes) of these symptoms in the study population. Finally, we will merge this data with the demographic and comorbidity data. For those with mTBI, the data from their comprehensive TBI evaluation will be studied to examine the factors associated with these phenotypes. As a result, we will be able to identify specific phenotypes of cognition and behavior in Veterans with epilepsy and mTBI. We will be able to determine if those patterns are different among individuals who have an epilepsy after mTBI. We will also abstract the word concepts from the medical records that patients or clinicians use to describe these cognitive and behavioral symptoms. We will input these into a computer program that can be used in the future to read, interpret, and understand large amounts of clinical text.

This will help us identify these symptoms and subtypes earlier among those with diseases such as epilepsy or dementia. It will also help us to monitor those that have exposures, such as TBI, that are at increased risk for cognitive and behavioral problems. These findings will aid for a better care coordination between neurologists/epileptologists and neuropsychologists providing subspecialty care for patients with epilepsy.