Call to Action: Volunteers Needed to Support Returning At-Risk Veterans

Caroline Cassels

December 03, 2007

December 3, 2007 (Philadelphia, PA) — In anticipation of the need to provide timely evaluation, diagnosis, and treatment of returning veterans who may be at increased risk of developing posttraumatic epilepsy (PTE), the American Epilepsy Society (AES) has launched Operation Giveback.

Led by Marc Dichter, MD, PhD, from the University of Pennsylvania, in Philadelphia, the voluntary effort is designed to raise awareness of the signs and symptoms of PTE among the public and the medical community through a series of national initiatives.

"Many people have become very concerned about the plight of our returning war veterans. We know the 2 signature injuries [of the current Iraq and Afghanistan conflicts] are limb loss and traumatic brain injury [TBI]. We can't do anything about the war, but we can do something about the posttraumatic epilepsy that many of these men and women may develop," Dr. Dichter said in a press conference here at the AES 61st Annual Meeting.

The AES is organizing a national network of epilepsy specialists who would be willing to volunteer their time at Veterans Administration (VA) healthcare facilities. It is also encouraging its members to support legislation currently before the US Senate (Senate bill S.2004) and House of Representatives (HR. 2818) to support epilepsy centers of excellence in the VA health system and a national coordination of epilepsy care.

Numbers Uncertain

While the program was officially announced at the AES annual meeting, much of the work to get the various aspects of Operation Giveback up and running has already been completed.

"We've already become significant advocates for increased funding for the Veterans Administration and the Department of Defense to help them develop increased expertise in epilepsy," said Dr. Dichter.

According to Dr. Dichter, the proportion of brain-injured veterans who will ultimately develop PTE is uncertain. "We know that in other wars, most of the injuries were due to penetrating head wounds — from bullets or shrapnel — and quite frankly, many individuals with extensive head injuries died."

In the Vietnam and Korean wars, PTE developed in more than 50% of TBI victims with penetrating head injury. In the current conflicts, penetrating head wounds are much less common, and survival rates have improved. However, the numbers of concussive closed head injuries, a major risk factor for epilepsy, have increased significantly.

"We don't know yet what the long-term consequences will be, but they are probably going to be significant," he said.

According to a report by the Brain Injury Association of America, as of March 24, 2007 a total of 12,274 US service members have sustained a TBI in either Iraq or Afghanistan, but it projects this number "could grow as high as 150,000."

Other estimates assert that 22% of all returning service personnel have some form of TBI. Of these, 69% are reportedly due to roadside bombs, rocket-propelled grenades, and other blasts. TBI screening, which began in August 2007 at the National Naval Medical Center, showed 83% of wounded Marines and sailors had brain injury.

Atypical Signs, Delayed Presentation

The signs and symptoms of PTE can be subtle and may not manifest for months or years after the initial insult. "If veterans develop symptoms a year after being mustered out, they may not think it has anything to do with an [improvised explosive device] IED explosion they experienced a year ago," said Dr. Dichter.

He added that the AES is particularly concerned about individuals who develop symptoms not typically associated with epilepsy, such as changes in personality or cognition.

To help build public awareness about the signs and symptoms of PTE, educational materials have been developed for patients and their families that are now available on the AESWeb site.

Further, the society has also created an educational program for its AES members to help them raise awareness of the signs and symptoms of PTE among health professionals in their own communities.

In addition, said Dr. Dichter, the AES plans to reach out beyond the neurology community to other healthcare professionals to create a greater understanding of PTE.

Psychiatrists in particular may be one of the first points of contact for veterans and may be able to detect some of the more "subtle" signs and symptoms of PTE.

"Our goal is to reach as many people in the trenches as possible to make them aware of this, so they can refer veterans back to specialists for full evaluation," he said.

For more information contact Dr. Dichter at dichter@mail.med.upenn.edu.

American Epilepsy Society 61st Annual Meeting. Presented December 1, 2007

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