Major Financial Impact, Disability Tied to Post-TBI Epilepsy

BALTIMORE ― Epilepsy that occurs following traumatic brain injury (TBI) is tied to significant disability and financial costs, new research suggests.

A retrospective analysis of a national database shows that patients who develop epilepsy after TBI are 20% more likely to have a major disability compared to patients with TBI but who do not develop epilepsy, and the cost to the healthcare system is increased by $22,000.

These results highlight the importance of appropriate management of patients who develop seizures following a brain injury, the researchers note.

"A large number of people suffer from post-TBI epilepsy every year," study investigator Urvish Patel, MBBS, MPH, research associate in the Department of Neurology, Creighton University School of Medicine/CHI Health, Omaha, Nebraska, told Medscape Medical News.

"So this research should provide an impetus to do more work on interventions for early identification, prevention, and management of epilepsy following TBI to mitigate the healthcare burden," Patel added.

The findings were presented here at the American Epilepsy Society (AES) 73rd Annual Meeting 2019.

Lack of Information

About 2.87 million Americans experience a TBI each year. Patel pointed to a study funded by the Centers for Disease Control and Prevention that showed that in the United States in 2013, more than 280,000 patients were hospitalized for TBI.

Whether a case is classified as post-TBI epilepsy depends on the duration between the TBI and the first seizure, Patel told meeting attendees. There are three categories of post-TBI epilepsy: immediate (up to 24 hours after injury), early (up to 7 days), and late (more than 7 days).

The incidence of early seizures after TBI is reportedly 2.6% to 16.3%.

Previous studies focused on mortality among patients with TBI who develop epilepsy, but information on disability and healthcare burden has been lacking, Patel noted.

The current population-based retrospective cross-sectional study used data from the Nationwide Inpatient Sample database. The study included 1,819,423 adult patients with TBI who were hospitalized between January 2003 and December 2014.

Of these patients, 3.98% developed epilepsy or seizures during hospitalization.

The severity of disability was classified on a scale of 0 to 4, with a higher score indicating more disability. On this scale, a score of 3 indicates major loss of function, and 4 indicates extreme loss of function.

Patients were also assessed as to whether they were discharged home or to a rehabilitation facility or nursing home.

More Disability

Results showed that for patients with post-TBI epilepsy, the prevalence of major or extreme disability on discharge was higher than for patients with TBI who did not develop epilepsy (47.22% vs 34.31%; P < .0001)

Patients with post-TBI epilepsy were also more likely to be discharged to a facility other than their home (54.15% vs 42.98%, P < .0001).

A multivariable regression model that adjusted for a number of confounders, including demographics, type and location of hospital, and comorbidities, showed that post-TBI epilepsy and seizures were associated with higher odds of a major or severe disability (adjusted odds ratio [aOR], 1.20; 95% confidence interval [CI], 1.15 – 1.25) and of being discharged to a rehabilitation facility (aOR, 1.31; 95% CI, 1.26 – 1.36).

The investigators also found that the cost of hospitalization was $85,463 for a patient with both TBI and epilepsy, compared with $63,243 for a patient without epilepsy ― a difference of $22,220 (P < .0001).

"This is one of the first and largest studies to show the degree of disability, discharge outcomes, and healthcare cost burden in TBI with and without seizures," Patel said.

"More research is needed to obtain disease-modifying interventions" during the latent period between a TBI and a diagnosis of epilepsy, he noted.

Because the investigators did not have access to outpatient records, the prevalence and frequency of post-TBI epilepsy might be underestimated, he added.

Clear Demonstration

Commenting on the study for Medscape Medical News, new AES President William Gaillard, MD, professor of neurology and pediatrics, the George Washington University School of Medicine and Health Sciences, Washington, DC, said the research clearly shows that adults with TBI who develop epilepsy have more severe disability and increased medical care costs.

"The study emphasizes the potential important role of epilepsy in the lives and care of people with TBI," said Gaillard, who is also the director of the Comprehensive Pediatric Epilepsy Program at Children's National Hospital.

However, it's not clear from the study whether it's actually the epilepsy that drives the disability and costs, he noted.

"Or is epilepsy a marker of more severe brain injury?" Gaillard asked.

The study authors and Gaillard have reported no relevant financial relationships.

American Epilepsy Society (AES) 73rd Annual Meeting 2019: Abstract 1.241 (platform session E08). Presented December 9, 2019.

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