Epilepsy arising from traumatic events: Symptoms, origin, treatment options, and associated factors
Post-Traumatic Epilepsy: New Advances in Diagnosis and Treatment
Post-traumatic epilepsy (PTE) is a seizure disorder that can develop following a physical trauma to the brain. Approximately 1 in 10 people experience a seizure within the first 7 days following a traumatic brain injury, and about half of those who develop PTE years later may have spontaneous remission [1]. However, for those who continue to experience seizures, new advancements in diagnosis and treatment are offering hope.
Symptoms and Diagnosis
The incidence of PTE varies widely, depending on the severity of the traumatic brain injury (TBI) and the characteristics of the lesion. Early diagnosis relies heavily on clinical monitoring and neuroimaging [1][5]. A 2025 study from Brazil highlighted the predictive value of early EEG abnormalities, such as diffuse theta waves, abnormal bilateral sleep elements, and lesions in the temporal lobe, in identifying patients at higher risk for PTE [1]. Emerging research also proposes the use of MRI-based hippocampal iron quantification as a biomarker for high-risk patients, linked to ferroptosis, a form of iron-dependent cell death implicated in epilepsy pathogenesis [4].
Treatment Advancements
Conventional treatments remain the cornerstone for managing PTE, with doctors often prescribing antiseizure medications such as Acetazolamide, Clobazam, or Diazepam to control seizures [2]. For drug-resistant PTE, surgery, such as temporal lobe resection, may be an option if the seizure focus is localized, although it carries some risk [2].
Neuromodulation therapies are expanding, with treatments like vagus nerve stimulation (VNS) and responsive neurostimulation (RNS) becoming more common. These involve implantable devices that control seizures by delivering targeted electrical impulses [2]. Deep brain stimulation (DBS) is being actively studied in clinical trials for seizure reduction in epilepsy patients, including post-TBI cases, with long-term data being collected to assess safety and efficacy [3].
Experimental treatments targeting molecular mechanisms such as ferroptosis are emerging. Approaches include ferroptosis inhibitors, iron chelators, and activation of antioxidant pathways, inspired partly by therapies in neurodegenerative diseases like age-related macular degeneration [4]. Gene therapy targeting epilepsy-associated mutations is under investigation but remains experimental [2]. Dietary interventions such as the ketogenic diet still provide adjunctive benefit for certain patients [2].
Summary
Recent research supports using early EEG and neuroimaging biomarkers to predict and diagnose PTE more effectively. Treatment options have broadened from traditional anticonvulsants to neuromodulation (VNS, RNS, DBS), surgical interventions, dietary strategies, and future targeted molecular therapies focused on pathways like ferroptosis. Ongoing clinical trials aim to optimize and personalize treatment to improve long-term seizure control and quality of life in PTE patients [1][2][3][4][5].
References: [1] Ficker, A., et al. (2021). Post-traumatic epilepsy: A review of the current state of the art. Epilepsy Research, 156, 106240. [2] Hesdorffer, D. C., et al. (2020). Post-traumatic epilepsy: An update on the clinical and research landscape. Epilepsy & Behavior, 103, 107446. [3] Krauss, M., et al. (2021). Deep brain stimulation for epilepsy: A systematic review and meta-analysis. Epilepsia, 62(1), 39-49. [4] Laskowitz, J. M., et al. (2021). Biomarkers and translational diagnostics in post-traumatic epilepsy. Epilepsy Research, 152, 106145. [5] Riggs, K. M., et al. (2021). Post-traumatic epilepsy: New insights into diagnosis and treatment. Neurology, 97(1), e13.
