Introduction

Abstract

Traumatic brain injury affects over 700,000 people in the United States each year. Of this number, about 75,000 will die of the immediate injury and an additional 90,000 will suffer long-term consequences, including the 20,000 who can be expected to subsequently develop epilepsy. These numbers are particularly impressive when one considers that those at highest risk, the young adult, will lose many productive years due to consequences of the condition. Population-based studies of newly diagnosed epilepsy suggest that up to 10% of all new cases can be attributed to traumatic brain injury. Cases affected with epilepsy are predominantly in the young adult population. There have been consistent efforts to reduce the frequency of traumatic brain injury. Primary prevention efforts include mandatory use of motorcycle helmets, seat belts, and bicycle helmets. The success of such programs is unclear, although the incidence of traumatic brain injury has fallen in the last 10 years. Better understanding of the epidemiology of traumatic brain injury may lead to other efforts in primary prevention. There has also been considerable effort to reduce the consequences of traumatic brain injury. Most notable have been efforts to intervene in the occurrence of posttraumatic epilepsy through early therapeutic interventions. To date, attempts at prophylaxis have been unsuccessful in preventing epilepsy, although there are some interventions that reduce the proportion of people with severe traumatic brain injury who experience seizures in the immediate period following the injury. In this supplement, we review the epidemiology of traumatic brain injury, the epidemiology of posttraumatic epilepsy, risk factors for posttraumatic epilepsy, and the justification for and results of studies of attempts to prevent posttraumatic epilepsy. We also present experimental data suggesting alternative methods of drug administration for prevention. Since there is a potential down side to any therapeutic intervention, we also discuss the impact of some antiseizure drugs on non-neuronal brain structures. We hope this review will provide insights into characteristics of posttraumatic epilepsy and stimulate further interest in both primary prevention of traumatic brain injury as well as the identification of intervention that may reduce or prevent the consequences of traumatic brain injury.