Understanding Epilepsy After Brain Injuries: A Deep Dive Discussion

0:00:09 - Shane Smith Hey, Shane Smith here on Mind Matters: Navigating Head Injuries and Concussions. I'm here with Thomas. He's one of the attorneys in the concussion and brain injury group at Shane Smith Law. Today we're going to talk a little bit about well, I mean, we're always talking about brain injuries, but today we're going to talk specifically about one of the repercussions of some brain injuries you can have. And what is that today Thomas, epilepsy?

0:00:32 - Thomas Ozbolt Epilepsy and seizures. That's one of the cascade effects that can be caused by a traumatic brain injury. You know it sets off a cascade of events within the brain, disrupting its normal functioning. One of the significant concerns that you have is the potential development of seizures and epilepsy.

0:00:47 - Shane Smith And I know to me, well, tons of things that happen from brain injury are scary. But most of those are scary to the person, you know experiencing the forgetfulness. You know most of it's felt by that one individual and it's hard for me just to look at you and know, hey, this is what's going on. But absolutely, in seizures I feel like have a disruptive effect, even more so than everything else, on the family, because everybody can see it right, and I knew somebody who had epilepsy when I was a child and they were terribly embarrassed. Anytime they had epilepsy they were mortified and embarrassed that other people saw it and all of those things. I'm going to guess it's the same and if not worse for our brain injury people.

0:01:22 - Thomas Ozbolt Yeah, when we talk about seizures post brain injury, we're not only referring to those immediate post traumatic seizures but also the potential for epilepsy to develop over time. Now, when you have a traumatic brain injury and the disruption of that normal brain activity that can lead to abnormal electrical discharges within your brain that trigger seizures. Epilepsy is essentially two or more uncontrolled seizures.

0:01:46 - Shane Smith I guess you said two or more, so one's not epilepsy, but if you have two or three, is that automatically determined to be epilepsy?

0:01:53 - Thomas Ozbolt Epilepsy is essentially yeah, two or more uncontrolled seizures. So if you have that first one no, it's not epilepsy, that can happen, but if you have two or more, then they're uncontrollable. I don't know if that's ever controlled.

0:02:06 - Shane Smith I was going to say, what's controllable mean for a seizure? Is it like medication, so you have one and I put you on this medicine and you don't have it again? Is that sort of the controllable aspect of a seizure? Yeah, that is definitely part of it. You know everybody says abnormal electrical charges, but it was really just the brain misfiring right?

0:02:25 - Thomas Ozbolt In a way yeah, and you know one of the most important things in figuring this out is diagnosing a seizure. There's a lot of different types of seizures that can happen or ways that they manifest themselves. And get the diagnosis right when you have that abnormal electrical discharge, that's really crucial.

0:02:44 - Shane Smith How do they diagnose it, what is that?

0:02:44 - Thomas Ozbolt That's a great question. There's several things that are very important to it. Of course you have imaging studies like a CT scan or an MRI. Those will play a crucial kind of high level role in understanding the extent of the injury and identifying potential areas of concern. But of course those are high levels. They don't often get down to a more micro level that you need. Really with incidents like these, eye witness accounts are invaluable and they're crucial in corroborating the occurrence of seizures.

0:03:13 - Shane Smith So I would think the odds of you having a seizure while you're in the CT scan or the MRI are pretty minimal. Pretty minimal. Yes, they have to be just freak timing kind of deal. So most of it is yeah, the CT scan or MRI may show some damage to the brain or some issues, but most of it's eye witness right? People who saw you have this activity.

0:03:30 - Thomas Ozbolt Yeah, and a lot of- there are kind of some what you call kind of triggers or warning signs that a person might experience when they're about to have a seizure. Some of those include having an unusual or a disagreeable odor that they sense, or even having a deja vu experience.

0:03:48 - Shane Smith But the disagreaable odor. There's no real smell there, right. They don't begin to smell. They just, something's triggered, so they smell some weird thing.

0:03:55 - Thomas Ozbolt Yeah, it's called an aura and what that's caused by is the seizure starting in a localized part of your brain. So it's starting in a particular segment of your brain, one that might control smell or might control memory, the seizure's starting there. And a person's actual physical appearance and how those symptoms manifest in terms of what someone's looking at, can give you clues as to the location of the electrically abnormal part of the brain.

0:04:25 - Shane Smith Really? So just, I mean if I had all the training and we're a doctor and all that and I see you having a seizure, I might be like, oh, he's got a brain injury at this one part of his brain just by your behavior. It's that specific?

0:04:36 - Thomas Ozbolt Yeah. And you know, oftentimes eye witness accounts get discounted by, you know, defense attorneys or adjusters. But what a doctor is gonna do is they're gonna talk to family members, they're gonna talk to people who are present on the scene. They're gonna say well, you know, when the seizure started, what did you see on the person? Well, I saw his right arm jerking and the right side of his face twitching. That would tell them more than likely that the seizure focus is in the motor strip of the left frontal lobe of the brain. Now, if you're having a seizure focus in that left frontal lobe of your brain and it's confined to that area, you might not have a loss of consciousness, but most of the time when you have that abnormal electrical activity, it spreads from one particular area of your brain, one particular focus, to the entire brain.

0:05:21 - Shane Smith Really, okay. So you got like a virus, almost right? It's in one spot then all throughout, like or a lightning I don't know the right word but like a lightning storm, or even if I drop food coloring in a pot of water, right? It hits, that's where the seizure starts and then it spreads throughout the- as far as I can go?

0:05:37 - Thomas Ozbolt Yeah, it's like you know, there's the famous saying I don't know who said it, it's when you drop a pebble into a pond, even after the pebble has hit the bottom of the pond, you know, the water still trembles. The same thing applies with your brain, and you know, when you have it spread to the rest of your brain, that seizure is quickly followed by a loss of consciousness and convulsive activity on both sides of your body. So this changes from being, you know, seizure focused in one area to what we call focal seizure with secondary generalization.

0:06:07 - Shane Smith Now we talked a little bit about seizures. What is a seizure right? Because to me the seizure, you know, the only image I have is, you know, the person who falls down on the ground and convulses that I used to see when I was a child, basically. But there are other types of seizures as well you can run into right?

0:06:25 - Thomas Ozbolt Yeah, there are different types of seizures. One of those would be the focal seizure with the impairment of consciousness. This is where you might see you know, you're not always going to see a loss of consciousness with a seizure. You might see an altered state of consciousness where you see someone who's not awake but unresponsive, and they might just be staring or doing automatic repetitive movements like smacking their lips or picking at their clothing.

0:06:53 - Shane Smith But they're not really there.

0:06:54 - Thomas Ozbolt Right, they're in an altered state of consciousness. That's what you would call, it used to be called a petite mal or a complex partial seizure, but that's what you know I kind of referred to a second ago called the focal seizure with the impairment of consciousness. Now there are other types aside from that one as well.

0:07:12 - Shane Smith I mean, how long do these things normally last? Are they all a few brief seconds, or can they last minutes?

0:07:17 - Thomas Ozbolt So it depends on your type. And so, for example, with generalized seizures, these occur with sudden onset over the entire brain at once, without a warning, and they come in different types. When you have these generalized seizures, you can have a tonic clonic seizure. With this type, there's no warning, you know, no aura, but there's a sudden loss of consciousness with multiple rhythmic, convulsive jerks of the arms and outward stiffening of the legs. These will last anywhere, usually from 30 to 120 seconds, so 30 seconds to two minutes. It's often accompanied by frothing at the mouth or losing control of your bladder or bowels and tongue biting. So, like you said, talking about embarrassment, I, you know, I had a friend at our church, you know another young person at our church that would happen and it was always terribly embarrassing. It didn't happen every time, but when it did it's, you keow there was going to be a lot of embarrassment. And then, with that tonic clonic seizure that we talked about, it's usually after you have that loss of control of the bladder is frothing at the mouth, the tongue biting, you know you have to roll the person on their side, the person's unresponsive and there's typically a snoring type of breathing for another 15 to 20 minutes. Oh wow, so it's definitely not quick. And that's called the post tictal state, and so that's just kind of you know, that that's the medical term for that afterwards.

0:08:35 - Shane Smith And I know people who've had this and basically why you could say, well, you're only having seizures. But when you have these major seizures, all the embarrassment, that makes them almost afraid to leave the house because they're afraid to embarrass in front of church or friends or everybody right? It just becomes this closeted, devastating impact right?

0:08:54 - Thomas Ozbolt Right, yeah, so several other downstream effects you know. You think about depression. You think about, you know, loss of friendships. You know, just like you said, just being totally embarrassed. It can even go beyond this in terms of different types of seizures. You got what you call recurrence. When you have recurrence seizures, you know one after the other when you're not gaining consciousness. This is really scary. It's called status epilepticus. Okay. And this is a medical emergency and that must be treated immediately or permanent brain damage can result. The other particularly scary thing about this is in the traumatic brain injury context. This is something that children are much more likely to develop. So you think about how terrifying that is seeing, you know, your young daughter or son having a traumatic brain injury and saying, hey, this is a subset of the population that's more likely to be a risk for status epilepticus.

0:09:43 - Shane Smith And this is sort of the seizure that never ends until medicine comes into play is that it? Yeah, it's, it's, you know, they are just, it's almost, you want to say, being hit by wave after wave of this. And you know that's got to be devastating for the person, devastating for the family member. You probably just assumed they were dying. Yeah, it's, yeah, I mean it- and they can die, or never be the same, I mean without the right medical care. And think about how you're waiting for an ambulance to get there, right?

0:10:08 - Thomas Ozbolt Yeah, and you think in those, those periods, you think about brain damage and how quickly it can happen. It's, you know, the seconds matter, minutes matter, you know loss of brain function. You know you might not die, but you might not ever be- you might be a shell of who you were before or never realize who you were going to be, if you're a kid. So yeah, the description of the seizure, you know an eye witness account that they give at the time of the seizure, that's important in that seizure diagnosis.

0:10:31 - Shane Smith And I never really, I never would have thought, okay, pay super attention if you were to see somebody to everything that's going on, how it started, because that's the key. If they didn't know, if they don't have that diagnosed with the injuries, that's a huge key right for, for everybody? Tells the doctors where to start looking.

0:10:49 - Thomas Ozbolt Right, because you have, you have diagnostic tools, right? We talked about CAT scans, we talked, or CT scans, we talked about MRIs. There's EEGs. But here's the really interesting thing about that. You know they can help determine the nature of the seizure, if you talk about EEG, but about 10% of patients with known epilepsy never in their lives have an abnormal EEG between seizures. Wow. And it's not, you know, you're not ever really gonna be able to catch someone with an EEG right when they have it.

0:11:17 - Shane Smith Yeah, like we say, you'd have to just be sitting in the doctor's office and have crazy timing.

0:11:28 - Thomas Ozbolt And then 50% patients with a first seizure who subsequently develop epilepsy, they have a normal initial EEG.

0:11:31 - Shane Smith So they thought they were okay, they had the brain injury, thought they're okay and then bam, that hits.

0:11:32 - Thomas Ozbolt Nothing about the diagnostic tools that told them that this was gonna be something that they're at risk for, and it's again the eye witness accounts that really tell us.

0:11:48 - Shane Smith So in our- we'll flip to the legal side now. I mean so the fact that somebody had a negative EEG or normal EEG is helpful, but it's certainly not persuasive if 50% of them don't have it or have a normal one, until something happens, until they don't, basically right?

0:11:59 - Thomas Ozbolt Yeah, it's, it's almost, you know, searching for a needle in the haystack if you're, if you're trying to find this on an EEG.

0:12:06 - Shane Smith I think it's important to know Thomas. This is sort of a deeper topic. We're gonna do two podcast episodes on this now. And if- this one we talked a lot about triggers and what happened and what epilepsy was, and all this. In our next episode we're gonna talk about the treatment and how they treat car accident or brain injury types of epilepsy, which is very similar to regular epilepsy. We'll be covering that in next week's episode. So for all of our listeners out there, if you've enjoyed this topic or find it interesting, if you hit like and subscribe so you can see our newest episodes. If you hit the bell you'll see the notification when the new episodes come out and if you have a brain injury or questions or concerns about this issue, or were in an accident and suffer this and would like to talk to one of our attorneys in the concussion and brain injury group, just give us a call at 980-999-9999. And remember if you're in pain, call Shane or go to our website. We've got tons of information there as well. Thanks.