Three studies coming out of the American Epilepsy Society’s 67th Annual Meeting in Washington DC expose the high prevalence of epilepsy and other neurological disorders in US Veterans who served in Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn. The research conducted from these studies indicate that veterans are at a particularly high risk for traumatic brain injury (TBI), post traumatic stress disorder (PTSD), psychological non-epileptic seizures (PNES) and epileptic seizure diagnoses.
A study by the Southeast Epilepsy Centers of Excellence and Duke University Medical Center found that 87,377 Veterans with seizures diagnoses were managed within the Veterans Health Administration during the 2011 Fiscal Year. The prevalence rate was 15.5 per 1,000 and incidence was 148.2 per 100,000. Higher incidence of diagnoses was found in young veterans under the age of 46.
“Appropriately diagnosing and treating Veterans with TBI and PTSD is notoriously difficult,” said Tung T. Tran, MD. “It involves a multidisciplinary approach to include both epilepsy and mental health specialists.”
Another study from the Baylor College of Medicine in Houston, Texas reviewed the results of video-EEG (VEEG) monitoring data for veterans of OEF/OIF from the Michael E. DeBakey VA Medical Center from January 2008 to May 2013. The study uncovered a comparatively higher prevalence for psychogenic non-epileptic seizures (PNES) among OEF/OIF veterans who completed the VEEG monitoring. Among patients with a definitive diagnosis of PNES, 63% of the subjects had PTSD alone, 50% had mTBI alone, and 41.3% had a combination of the two. Alarmingly 90.6% of subjects with PTSD who received definitive VEEG diagnoses also had PNES.
“Our research identified the presence of mild traumatic brain injury (mTBI) and PTSD,” said Shirish Satpute, DO. “Both were common morbidities in this population, and appear to be independently predictive of subsequent VEEG confirmation of PNES.”
As both of the previous studies indicate, the record of US Veterans diagnosed with psychogenic non-epileptic seizures (PNES) is overwhelming, but there is no existing data regarding the outcome of these patients. The acquisition of this information is vital to assessing prognostic factors and planning therapeutic trials. Researchers reviewed all patients meeting criteria for PNES at the Portland, Oregon VAMC EMU from 2000-2011. Following the Epilepsy Monitoring Unit diagnosis of PNES, the majority of veterans continued to report seizures, even after 3 years of follow up.. Only 21% remained continuously seizure free. However, more than 80% of PNES patients who received antiepileptic drugs (AEDs) for seizures prior to EMU evaluation remained continuously off AEDs through 36 months of follow-up.
“The unsatisfactory seizure outcomes underscore the need for effective PNES treatment protocols within the VAMC,” said Martin C. Salinsky, MD. “On a positive note, the elimination of unnecessary AED therapy could avoid potential side effects and reduce the cost of care."
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