The Military Injuries-Understanding post-Traumatic Epilepsy Study: Understanding Relationships Among Lifetime TBI History, Epilepsy, and Quality of Life.

Abstract

Understanding risk for epilepsy among individuals who sustain a mild traumatic brain injury (mTBI) is crucial for effective intervention and prevention. However, mTBI is frequently undocumented or poorly documented in health records. Further, health records are non-continuous, such as when individuals move through health systems (e.g., from Department of Defense (DoD) to Veterans Affairs (VA), or between jobs in the civilian sector), making population-based assessments of this relationship challenging. Here, we introduce the Military INjuries-Understanding post-Traumatic Epilepsy [MINUTE] study, which integrates data from the Veterans Health Administration with self-report survey data for post-9/11 Veterans (n=2603) with histories of TBI, epilepsy, and controls without a history of TBI or epilepsy. This paper describes the MINUTE study design, implementation, hypotheses, and initial results across four groups of interest for neurotrauma; 1. Control, 2. Epilepsy, 3. TBI, and 4. Post-traumatic epilepsy (PTE). Using combined survey and health record data, we test hypotheses examining lifetime history of TBI, and the differential impacts of TBI, epilepsy, and PTE on functional outcomes. The MINUTE study revealed high rates of undocumented lifetime TBIs among Veterans with epilepsy who had no evidence of TBI in VA medical records. Further, worse physical functioning and health-related quality of life was found for individuals with Epilepsy+TBI compared to those with either epilepsy or TBI alone. This effect was not fully explained by TBI severity. These insights provide valuable opportunities to optimize the resilience, delivery of health services, and community reintegration of veterans with TBI and complex comorbidity.