The prevalence of epilepsy and association with traumatic brain injury in veterans of the Afghanistan and Iraq wars

Mary Jo V. Pugh*, Jean A. Orman, Carlos A. Jaramillo, Martin C. Salinsky, Blessen C. Eapen, Alan R. Towne, Megan E. Amuan, Gustavo Roman, Shane D. McNamee, Thomas A. Kent, Katharine K. McMillan, Hamada Hamid, Jordan Henry Grafman

*Corresponding author for this work

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

OBJECTIVE:: To examine the association of epilepsy with traumatic brain injury (TBI) in Afghanistan and Iraq (Operation Enduring Freedom [OEF]/Operation Iraqi Freedom [OIF]) Veterans. DESIGN:: Cross-sectional observational study. PARTICIPANTS:: A total 256 284 OEF/OIF Veterans who received inpatient and outpatient care in the Veterans Health Administration in fiscal years 2009-2010. MAIN OUTCOME MEASURES:: We used algorithms developed for use with International Classification of Diseases, Ninth Revision, Clinical Modification, codes to identify epilepsy, TBI (penetrating TBI [pTBI]/other TBI), and other risk factors for epilepsy (eg, stroke). TBI and other risk factors were identified prior to the index date (first date of seizure or October 1, 2009) for primary analyses. RESULTS:: Epilepsy prevalence was 10.6 per 1000 (N = 2719) in fiscal year 2010; age-adjusted prevalence was 6.1. Of 37 718 individuals with a diagnosis of TBI, 29 297 Veterans had a diagnosis of TBI prior to the index date. Statistically significant associations were found between epilepsy and prior TBI diagnosis (pTBI: adjusted odds ratio = 18.77 [95% confidence interval, 9.21-38.23]; other TBI: adjusted odds ratio = 1.64 [1.43-1.89]). CONCLUSIONS:: Among OEF/OIF Veterans, epilepsy was associated with previous TBI diagnosis, with pTBI having the strongest association. Because war-related epilepsy in Vietnam War Veterans with TBI continued 35 years postwar, a detailed, prospective study is needed to understand the relationship between epilepsy and TBI severity in OEF/OIF Veterans.

Original languageEnglish (US)
Pages (from-to)29-37
Number of pages9
JournalJournal of Head Trauma Rehabilitation
Volume30
Issue number1
DOIs
StatePublished - Jan 21 2015

Fingerprint

Afghanistan
Iraq
Veterans
Epilepsy
2003-2011 Iraq War
Afghan Campaign 2001-
Traumatic Brain Injury
Warfare
Penetrating Head Injuries
Odds Ratio
Veterans Health
United States Department of Veterans Affairs
Vietnam
International Classification of Diseases
Ambulatory Care
Observational Studies
Inpatients
Seizures

Keywords

  • Veterans
  • epidemiology
  • epilepsy
  • traumatic brain injury

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Neurology

Cite this

Pugh, Mary Jo V. ; Orman, Jean A. ; Jaramillo, Carlos A. ; Salinsky, Martin C. ; Eapen, Blessen C. ; Towne, Alan R. ; Amuan, Megan E. ; Roman, Gustavo ; McNamee, Shane D. ; Kent, Thomas A. ; McMillan, Katharine K. ; Hamid, Hamada ; Grafman, Jordan Henry. / The prevalence of epilepsy and association with traumatic brain injury in veterans of the Afghanistan and Iraq wars. In: Journal of Head Trauma Rehabilitation. 2015 ; Vol. 30, No. 1. pp. 29-37.
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title = "The prevalence of epilepsy and association with traumatic brain injury in veterans of the Afghanistan and Iraq wars",
abstract = "OBJECTIVE:: To examine the association of epilepsy with traumatic brain injury (TBI) in Afghanistan and Iraq (Operation Enduring Freedom [OEF]/Operation Iraqi Freedom [OIF]) Veterans. DESIGN:: Cross-sectional observational study. PARTICIPANTS:: A total 256 284 OEF/OIF Veterans who received inpatient and outpatient care in the Veterans Health Administration in fiscal years 2009-2010. MAIN OUTCOME MEASURES:: We used algorithms developed for use with International Classification of Diseases, Ninth Revision, Clinical Modification, codes to identify epilepsy, TBI (penetrating TBI [pTBI]/other TBI), and other risk factors for epilepsy (eg, stroke). TBI and other risk factors were identified prior to the index date (first date of seizure or October 1, 2009) for primary analyses. RESULTS:: Epilepsy prevalence was 10.6 per 1000 (N = 2719) in fiscal year 2010; age-adjusted prevalence was 6.1. Of 37 718 individuals with a diagnosis of TBI, 29 297 Veterans had a diagnosis of TBI prior to the index date. Statistically significant associations were found between epilepsy and prior TBI diagnosis (pTBI: adjusted odds ratio = 18.77 [95{\%} confidence interval, 9.21-38.23]; other TBI: adjusted odds ratio = 1.64 [1.43-1.89]). CONCLUSIONS:: Among OEF/OIF Veterans, epilepsy was associated with previous TBI diagnosis, with pTBI having the strongest association. Because war-related epilepsy in Vietnam War Veterans with TBI continued 35 years postwar, a detailed, prospective study is needed to understand the relationship between epilepsy and TBI severity in OEF/OIF Veterans.",
keywords = "Veterans, epidemiology, epilepsy, traumatic brain injury",
author = "Pugh, {Mary Jo V.} and Orman, {Jean A.} and Jaramillo, {Carlos A.} and Salinsky, {Martin C.} and Eapen, {Blessen C.} and Towne, {Alan R.} and Amuan, {Megan E.} and Gustavo Roman and McNamee, {Shane D.} and Kent, {Thomas A.} and McMillan, {Katharine K.} and Hamada Hamid and Grafman, {Jordan Henry}",
year = "2015",
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Pugh, MJV, Orman, JA, Jaramillo, CA, Salinsky, MC, Eapen, BC, Towne, AR, Amuan, ME, Roman, G, McNamee, SD, Kent, TA, McMillan, KK, Hamid, H & Grafman, JH 2015, 'The prevalence of epilepsy and association with traumatic brain injury in veterans of the Afghanistan and Iraq wars', Journal of Head Trauma Rehabilitation, vol. 30, no. 1, pp. 29-37. https://doi.org/10.1097/HTR.0000000000000045

The prevalence of epilepsy and association with traumatic brain injury in veterans of the Afghanistan and Iraq wars. / Pugh, Mary Jo V.; Orman, Jean A.; Jaramillo, Carlos A.; Salinsky, Martin C.; Eapen, Blessen C.; Towne, Alan R.; Amuan, Megan E.; Roman, Gustavo; McNamee, Shane D.; Kent, Thomas A.; McMillan, Katharine K.; Hamid, Hamada; Grafman, Jordan Henry.

In: Journal of Head Trauma Rehabilitation, Vol. 30, No. 1, 21.01.2015, p. 29-37.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The prevalence of epilepsy and association with traumatic brain injury in veterans of the Afghanistan and Iraq wars

AU - Pugh, Mary Jo V.

AU - Orman, Jean A.

AU - Jaramillo, Carlos A.

AU - Salinsky, Martin C.

AU - Eapen, Blessen C.

AU - Towne, Alan R.

AU - Amuan, Megan E.

AU - Roman, Gustavo

AU - McNamee, Shane D.

AU - Kent, Thomas A.

AU - McMillan, Katharine K.

AU - Hamid, Hamada

AU - Grafman, Jordan Henry

PY - 2015/1/21

Y1 - 2015/1/21

N2 - OBJECTIVE:: To examine the association of epilepsy with traumatic brain injury (TBI) in Afghanistan and Iraq (Operation Enduring Freedom [OEF]/Operation Iraqi Freedom [OIF]) Veterans. DESIGN:: Cross-sectional observational study. PARTICIPANTS:: A total 256 284 OEF/OIF Veterans who received inpatient and outpatient care in the Veterans Health Administration in fiscal years 2009-2010. MAIN OUTCOME MEASURES:: We used algorithms developed for use with International Classification of Diseases, Ninth Revision, Clinical Modification, codes to identify epilepsy, TBI (penetrating TBI [pTBI]/other TBI), and other risk factors for epilepsy (eg, stroke). TBI and other risk factors were identified prior to the index date (first date of seizure or October 1, 2009) for primary analyses. RESULTS:: Epilepsy prevalence was 10.6 per 1000 (N = 2719) in fiscal year 2010; age-adjusted prevalence was 6.1. Of 37 718 individuals with a diagnosis of TBI, 29 297 Veterans had a diagnosis of TBI prior to the index date. Statistically significant associations were found between epilepsy and prior TBI diagnosis (pTBI: adjusted odds ratio = 18.77 [95% confidence interval, 9.21-38.23]; other TBI: adjusted odds ratio = 1.64 [1.43-1.89]). CONCLUSIONS:: Among OEF/OIF Veterans, epilepsy was associated with previous TBI diagnosis, with pTBI having the strongest association. Because war-related epilepsy in Vietnam War Veterans with TBI continued 35 years postwar, a detailed, prospective study is needed to understand the relationship between epilepsy and TBI severity in OEF/OIF Veterans.

AB - OBJECTIVE:: To examine the association of epilepsy with traumatic brain injury (TBI) in Afghanistan and Iraq (Operation Enduring Freedom [OEF]/Operation Iraqi Freedom [OIF]) Veterans. DESIGN:: Cross-sectional observational study. PARTICIPANTS:: A total 256 284 OEF/OIF Veterans who received inpatient and outpatient care in the Veterans Health Administration in fiscal years 2009-2010. MAIN OUTCOME MEASURES:: We used algorithms developed for use with International Classification of Diseases, Ninth Revision, Clinical Modification, codes to identify epilepsy, TBI (penetrating TBI [pTBI]/other TBI), and other risk factors for epilepsy (eg, stroke). TBI and other risk factors were identified prior to the index date (first date of seizure or October 1, 2009) for primary analyses. RESULTS:: Epilepsy prevalence was 10.6 per 1000 (N = 2719) in fiscal year 2010; age-adjusted prevalence was 6.1. Of 37 718 individuals with a diagnosis of TBI, 29 297 Veterans had a diagnosis of TBI prior to the index date. Statistically significant associations were found between epilepsy and prior TBI diagnosis (pTBI: adjusted odds ratio = 18.77 [95% confidence interval, 9.21-38.23]; other TBI: adjusted odds ratio = 1.64 [1.43-1.89]). CONCLUSIONS:: Among OEF/OIF Veterans, epilepsy was associated with previous TBI diagnosis, with pTBI having the strongest association. Because war-related epilepsy in Vietnam War Veterans with TBI continued 35 years postwar, a detailed, prospective study is needed to understand the relationship between epilepsy and TBI severity in OEF/OIF Veterans.

KW - Veterans

KW - epidemiology

KW - epilepsy

KW - traumatic brain injury

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