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Study: Iraq-Afghanistan veterans who develop epilepsy more at risk of death

By J.P. LAWRENCE | San Antonio Express-News | Published: December 5, 2016

SAN ANTONIO (Tribune News Service) — Veterans who develop epilepsy were 2.6 times more likely to die during a five-year span than their peers, according to a study presented at an American Epilepsy Society meeting Sunday in Houston.

The study examined the records of 2,187 Iraq and Afghanistan veterans with epilepsy receiving VA care in 2010 and 2011. Over the next five years, these veterans with epilepsy were much more likely to have died than similar veterans without epilepsy. This is true even when researchers took into account other issues veterans had such as cardiac disease and cancer.

“If you had two people with the same conditions, one who had epilepsy and one that didn’t, the person with epilepsy is more likely to die than the other,” said lead author Mary Jo Pugh, professor of epidemiology, biostatistics and medicine at the University of Texas Health Science Center.

Epilepsy affects around 5.1 million Americans, according to numbers from the Center for Disease Control. In epilepsy, the normal pattern of brain activity is disturbed, causing strange sensations and sometimes convulsions, muscle spasms, and loss of consciousness.

Head trauma, stroke, brain tumor, and brain infection are the most common causes for epilepsy, but in 60 to 70 percent of cases the cause cannot be determined, according to the American Epilepsy Society.

A recent investigation by the Department of Defense indicated that epilepsy incidence increased by 52 percent from 2006 to 2010, with approximately 8 percent of those with epilepsy having a previous diagnosis of TBI.

Pugh began researching at epilepsy issues in veterans in 2000. Studies of Veterans from World War II and the Korean War identified linked epilepsy to traumatic brain injuries. One study done by Pugh showing 30 percent of those with a penetrating TBI developed epilepsy at some point.

“If you have a penetrating TBI, you are 20 times more likely to have epilepsy,” Pugh said.

A longer-term study on Vietnam veterans found 50 to 55 percent of those with penetrating TBI developed epilepsy over time. Symptoms of epilepsy often manifest as people age, Pugh said.

An estimated 15 percent to 19 percent of troops returning from Iraq and Afghanistan reported TBI with either loss of consciousness or altered mental status.

“Anyone with epilepsy is a relatively vulnerable population,” Push said.

People who have seizures can’t drive, Pugh said, which makes it difficult to stay employed. Veterans with epilepsy may be medically discharged and separated from the military, which can lead to a difficult integration.

People with epilepsy are more likely to have depression, PTSD, bipolar, suicidality. Pugh said the link goes in both directions: people with mental health disorders are more likely to develop epilepsy.

Doctors may also prioritize treating a patient’s epilepsy symptoms and then neglect more subtle issues such as high blood pressure, Pugh said.

“We need to take a holistic approach in epilepsy care,” Pugh said. “We need to take care of epilepsy and other conditions that affect patients’ health, quality of life and, ultimately, mortality.”

For 70 percent of those with epilepsy, medication can control the seizures, according to the National Institute of Neurological Disorders and Stroke.

The study included investigators from the The University of Texas Health Science Center at San Antonio, the South Texas Veterans Health Care System and the CDC.

This is the first published study to examine mortality in veterans with epilepsy, according to the UT Health Science Center.

Pugh and her team examined records of more than 320,000 Iraq and Afghanistan war veterans receiving VA care. These records did not list causes of death.

©2016 the San Antonio Express-News
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A doctor points to an MRI reading of a patient who has epilepsy.
MCT FILE PHOTO

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