Understanding the Impact of Head Injuries: The Seizure Connection

0:00:09 - Shane Smith
Hey, this is Shane Smith from Shane Smith Law. We're talking on the Mind Matters Podcast: Navigating Head Injuries and Concussions and all the effects associated with those. I'm here today with Thomas. He's one of the attorneys here at Shane Smith Law with the Concussion and Brain Injury Group. We're talking a lot about seizures and car accident or head injury related epilepsy, which is very similar to regular epilepsy and is essentially the same thing. We're talking about that in our episode today. When our clients have the trauma, they have the impact that in our case, usually a car accident or some kind of slip and fall they hit their head.

They have the trauma. When do they start showing up? What happens after that?

0:00:46 - Thomas Ozbolt
Yeah, so first, you know, talking about post-traumatic seizures, these will depend on the severity of the injuries. Some studies say that, and this is a very, you know, wide range, four to 53% of people will have these, while others say it's 35 to 65%.

0:01:04 - Shane Smith
But either, so it's a bunch, either way, I guess four, four out of a hundred. I know people who bet with those odds. You know all the time and gambling. But four to fifty percent. Fifty percent is one out of every two people with a brain injury, right, and 35 to 65 percent is two out of every three right?

0:01:18 - Thomas Ozbolt
Yeah, it's uh, you know, definitely needs some more studies done on it, but it's uh, there's definitely a high, there's a high chance of it. It seems at least likely.

0:01:27 - Shane Smith
And that's one seizure, or is that, that's seizures developing into epilepsy? Well, I guess that's the triggering seizure, right?

0:01:36 - Thomas Ozbolt
Yeah. And so usually, depending on the severity of the injury, that will increase the likelihood of a seizure. So five to 7% of people who are hospitalized as a result of the TBI, five to seven percent of those have at least one seizure. They show up in greater incidents with penetrating head trauma. So post-traumatic seizures, you know they're classified according to when they happen in relation to the injury. And there's three categories for that. There's immediate, early and late.

0:02:01 - Shane Smith
One thing you got me thinking about Thomas is you said you know, one of the types of seizures people have is where they're just not there. You know, right? They may be looking forward, but they're, you know, they're off somewhere else, basically.

Their own mind is going, I don't want to say frequently, but many times in car accidents there are people who've hit their head, and many people on the scene will be like, yeah, they just weren't responsive to me, or they weren't, you know, even when they're sitting out on the curb, they're just not responsive to me. Is this a seizure, or is this like a loss of consciousness, or is it, would that qualify as a seizure, or could it qualify, I guess?

0:02:31 - Thomas Ozbolt
Yeah, I think it's a great question. And you know, one of the ways of thinking about it is, you know, it definitely could be. You know it depends on the diagnostics that they get done, how detailed those descriptions are. Certainly the way that people describe things, or they talk about the aftermath and looking at somebody, they, that certainly sounds like a seizure in a lot of cases. But you have to think that it's one of these things that can't always be caught.

And a lot of medicine, you know, whether we like it or not, or whether insurance adjusters, defense attorneys, plaintiffs attorneys, a lot of it's kind of guesswork. You know, doctors can't know everything. We give them this power to, to know kind of everything. We put everything in their hands but, man sometimes they just don't have the information to know it. It certainly seems like, and you talk about concussion in an altered state of consciousness. Yeah. If you have that altered state of consciousness and there's other kind of convulsive movements going along with it that somebody observed, I think you definitely could have a diagnosis of a seizure.

0:03:25 - Shane Smith
Well, because I know it's not uncommon for children, for instance, to fall and hit their head and have a seizure, right then. So I don't know what would be different about car accident having that seizure as well. Right, you know, and I know that's every parent's, I mean get scared to death if their kid hits their head and has a seizure. But that doesn't, you know, I mean it's, it's there, it would seem like if you're in a car wreck, you hit your head, you're totally unresponsive, but your eyes are open and, that sounds like a seizure to me. And I guess that's where those eyewitness accounts matter so much, right, to corroborate what happens in the hospital, or even to tell the doctor right? You need to be paying attention to this, because if the doctor doesn't know, the EMT doesn't write it down, or the eyewitnesses don't write it down, and now you're talking, the doctor wouldn't even know to investigate that right?

0:04:06 - Thomas Ozbolt
Right. And you gotta wonder just how much it's being correctly diagnosed, cause you think oftentimes the picture that you hear about somebody at the scene of an accident is yeah, I showed up, you know, my husband. he was just sitting there on the curb, staring off into nowhere and just rocking back and forth. You know, it's like, to me that sounds, according to this definition, like that could be some seizure activity. But is that something that's going to be diagnosed? Is there more that we're going to learn? It certainly seems like, you know, like the brain, we're always learning something and maybe there will be more ways to find that out.

0:04:33 - Shane Smith
It seems like for our listeners that definitely, if you were to have a spouse or family member who, who was acting that way at the scene, to be particularly paying attention for a second seizure, right, or to something else that looks similar to that, so you can tell the doctor. Because I mean, two is, two is definitely seizures I would say right?

0:04:52 - Thomas Ozbolt
Yeah. And well, at least when you go to the doctor, talk to the doctor about what you saw the person doing at the scene.

It's not just an opportunity for them to talk, because they might not remember, you know, they might've been an altered state of consciousness. It's your job to advocate for your loved one and tell them what you saw when you got there. Because that could say, that could give the doctor the information they need to say huh, well, that's concerning. Let me do an EEG and figure out if there's any kind of abnormal electrical activity.

0:05:19 - Shane Smith
And when we talked before, you know you said the, I think the percentage of people who have an EEG that's normal, even who have epilepsy, you said was 10%, which sounds like a super small percentage, but that's one out of 10. Yeah. So if I line up 10 people with epilepsy, one of those people has a perfectly clean EEG all the time. Yeah. So I mean, and out of a 100, that would be 10 people. So I mean it's a significant percentage. So the EEG is gonna, it's there but it's not persuas-- I mean it's not persuasive to me.

10 out of 100, I mean, is a lot. Now, these all 10 people they came up clean, right?  

0:05:51 - Thomas Ozbolt
It's not a great tool. It's, it's more of the eyewitness accounts that are really gonna, you know, help, help the doctor. You can't measure that, it's, it's what somebody saw.

0:06:03 - Shane Smith
And the bad part is I, I can't be an eyewitness for myself, right? Right. I mean I've got other people that have to help me, right, because I might not even know it right? I mean, would I always know that I had that seizure? Or--

0:06:11 - Thomas Ozbolt
I don't think you know at all. I think you know you're, you're not, you're not there. And you, we talk with clients all the time. Well, I blacked out, I, I, I don't what happened, and then all of a sudden I was outside my car. So what other people saw that you know our client doing in that situation is crucial because they're not going to remember it. It's a lot of times there there's just, you know, that kind of localized amnesia to that event and there's just no memory of it.

0:06:34 - Shane Smith
So, so what we would tell everybody is, if your loved one is this way, pay close attention for the next bit. I mean because, another seizure could be coming, or another one that we can diagnose as a seizure can come, versus this one where they're like well, you had a loss of consciousness or something. We can diagnose that as a seizure and they can start looking for damage right?

0:06:53 - Thomas Ozbolt
Right. We talk about those different categories of how post-traumatic seizures are classified. You've got immediate, you've got early and you've got late. And those break down into different things that you can look for.

0:07:05 - Shane Smith
Let's talk about the categories of seizures and how they-- these are diagnosed, or these are types based on the time, right? When the seizure occurs? Right. And I think the first category was like immediate right? Immediate, boom.

0:07:18 - Thomas Ozbolt
Immediate occur at the time or within minutes to hours after the injury, with an incident rate of 1% to 4%. So only 1% to 4% are immediate seizures.

0:07:27 - Shane Smith
So 1% to 4% have an immediate seizure at the scene that's corroborated and diagnosed.

0:07:34 - Thomas Ozbolt
Right. Next category would be early seizure. When do those start? These occur within the first week after the injury. And that has an incident rate of 4 to 25%.

0:07:48 - Shane Smith
So significantly more. I mean obviously that's a big range, but that depends on which study you're following, right? And I mean the cynical part of me would say is, who's paying for that study? I mean cause some people would certainly want to minimize the number of seizures they have, and others just tell the truth is what I would say.

0:08:02 - Thomas Ozbolt
Exactly. And there are risk factors that can kind of tell you whether you're going to be more susceptible to an early seizure. You know some of those being, you know, development of early seizures occurs more likely when there's bleeding within the brain or skull, or when there's a loss of consciousness or when it's a pediatric age group. You know, like we talked about for children, they're at a greater risk for developing seizures than adults.

0:08:28 - Shane Smith
All right. So if I've got blood in the brain, definitely pay attention. Child, definitely pay attention. And what was the other one?

0:08:36 - Thomas Ozbolt
The other one is a loss of consciousness.

0:08:42 - Shane Smith
Alright. So if I got knocked unconscious, my family needs to be watching out for this? Right. And that's four to 25. So 25 is what? One out of every four people? Right. All right, I mean, who suffered a brain injury to seen one out of four? That's a lot. Right. What's the next category there?

0:08:51 - Thomas Ozbolt
Moving on to the late seizures. Okay. Maybe even more surprisingly, these occur with an incidence rate of 9% to 42%. Holy cow. These occur after the first week of the injury, with approximately 90% of these seizures happening within the first month.

0:09:09 - Shane Smith
Okay, so, so you're definitely not out of the woods after the first week. As a matter of fact, it's worse.

0:09:15 - Thomas Ozbolt
Right. It seems like it's more likely going to happen in this period. And that's where you have the disruption in the normal brain activity. And it leads to a lot of effects that take time to play out, something that's not appreciated a lot of times by you know, adjusters, defense attorneys, just you know, normal, everyday people. How would you know that?

0:09:32 - Shane Smith
So we've talked about the fact, that fact that you have the injury, you go home, you sort of think, I don't want to say think you're okay, but you think you're on the road to recovery and then this cascade effect now it's like the virus is in you kind of deal and it now, it gets worse. Which is why that incidence rate goes up.

0:09:49 - Thomas Ozbolt
Right. Boom, seizure. And you know I've had clients who say, yeah, you know I had this weird incident. I was in the shower, client actually just talking about her daughter. Her daughter was in the shower about a month after the crash happened, big rear end collision. Her daughter collapsed in the shower, had a seizure. Like, well, we don't know what's caught, what, you know, let's get to the doctor and get them to find out. But this is probably related to the brain injury she was diagnosed with.

0:10:13 - Shane Smith
I was going to say, according to the statistics you found in the medical peer reviewed articles because that's where these come from, is medical articles, I mean there's at least a 45% chance it was a car accident.

0:10:25 - Thomas Ozbolt
Yeah, I mean even get this. Most of these occur within the first year after the injury but the risk, it can extend out over 10 years.

0:10:35 - Shane Smith
Holy cow.

0:10:35 - Thomas Ozbolt
10 years after a brain injury. And you've got different risk factors that are associated with that for development. Those are some of what we've talked about. You've got, if there's intercranial bleeding at the time of head trauma, 10 years down the road, you could be it, you could be suffering from, from seizure. If you have a lower Glasgow coma score, if you're older than 65 years old or if there's, you know, prior chronic alcoholism of some issues.

0:11:00 - Shane Smith
So there's a whole bunch of things. So I guess what I take from this is, it's very difficult to know, and it can pop up, but you certainly shouldn't discount-- if anything happens in that first year, you definitely need to tell your doctor and your lawyer.

0:11:13 - Thomas Ozbolt
Right. And you know finding out, you know when, when you have that post-traumatic epilepsy or seizure. Post-traumatic epilepsy, that's a condition of having recurrent unprovoked seizures after the initial one. But the time period where you need to be keeping an eye on things is within that two years after your first seizure. Let's say you have one in that late period, two months after the crash, the injury. Within two years after that first seizure, 86% of those individuals will have a second seizure. Wow. If you have one within two years, 86%. 50 to 67% of those who experience a seizure after TBI will have their second seizure within the first year following the post-traumatic seizure.

0:11:58 - Shane Smith
Okay, so 50 to 60% have a seizure within the first year after having one. But then the stats if you extend it out a little bit further from that seizure to two years, it's like, did you say 80% if you've had one? What that says to me quite honestly is, hey, if you've had one seizure, you're probably having another one, and if you have two, that's epilepsy. And, and the issue with that is when we think about epilepsy, I know there are many that can impact lots of aspects of your life. It can impact your driver's license, impact to get a pilot's license, all these things that are no longer eligible for you.

Because, to be quite honest, the government is concerned. You may have another seizure while driving on the road right? Because it's not like you have a lot of warning. Some of these, there's no warning.

0:12:38 - Thomas Ozbolt
Yeah, affects a lot of things people like to do. Also, you know you think about all the activities that involve flashing lights. You know video games, television, movie theaters, amusement parks, all types of things that people like to do for leisure activity, you know that can trigger those epileptic episodes.

And you know, this is another really interesting fact is, when you look at, you know causes of epilepsy, traumatic brain injury is the leading cause of epilepsy in young adults. Wow. Think about a young person, a young adult that you know, and it's a leading cause of epilepsy for them.

0:13:10 - Shane Smith
So all those video game warnings, they're talking to these people right here, right? Yeah. To our listeners and people who have had one as a result of a car accident?  

0:13:20 - Thomas Ozbolt
Yeah, and you think about it, if you have one associated with the accident, your second one could be triggered by playing a video game, and then you essentially have a diagnosis of post-traumatic epilepsy at that point.

0:13:30 - Shane Smith
Wow. So I sort of thought there were two sort of two different things, you know right, but, but no, that's not the case. I mean the same warnings for everybody with epilepsy applies, or brain injury folks as well. And I think about moms and stuff, every one of them who has

a kid who's suffered a brain injury is going to then be concerned forever, right? I mean, I know my, my kids, when they were teenagers, loved to play video games and, and fortnite and all these things and the warnings, or you look at a movie and it pops up, or like you say, the roller coaster, all these things. As soon as you get that diagnosis, you're concerned about them and mom's gonna be worried, dad's gonna be worried, kid, you're gonna be worried.

0:14:05 - Thomas Ozbolt
Yeah, it's a game changer, a life changer. Everything changes, can change just like that.

0:14:12 - Shane Smith
So, once they do all these diagnoses, how do they treat folks? How do they help them? How do they help them deal with all of this? Is it medication, is it therapy? What are they doing?

0:14:21 - Thomas Ozbolt
Yeah, the goal here with recurring seizures is to prevent them from occurring. A seizure is harmful to a person's health because there's this tremendous metabolic stress that it places on the brain cells.

0:14:33 - Shane Smith
Merely the aspect of having the seizure, that alone causes damage and is harder on the body. I mean obviously, but I mean, it's devastating the body you said.

0:14:39 - Thomas Ozbolt
Right, it's just tremendous stress on these brain cells. And you think about what that does in terms of just exciting things and sending them to a new level in terms of their activity. This can endanger someone's life. You know, like you talked about, if it happens in a precarious position, like if someone's on the road. You know, we had a client, this happened to her while she was driving. Wow. It happened to her twice within a couple of weeks.

It's unfortunately a case we couldn't take, but that was you know something that happened to a client. And, or say you're working on a ladder as a construction worker, you have a seizure, you know it's over.

0:15:12 - Shane Smith
Or at home, just up on a ladder right? I mean, as we said a lot of times, there's no notice, so--

0:15:15 - Thomas Ozbolt
Right. And you know, if you talk about this happening within a month after an injury, you think everything's all right. You're working out on the ladder cleaning out the gutters and you know you have a seizure that, caused by your traumatic brain injury and your life's over.

0:15:29 - Shane Smith
Or a shower, bath? Yeah. The goal is to prevent them? Right. How do they do that?

0:15:31 - Thomas Ozbolt
Essentially, what we have to do this right now is medication, but there's no medication available that prevents the development of post-traumatic epilepsy.

0:15:40 - Shane Smith
It's not like I can just take something prophylactically to prevent it from occurring.

0:15:45 - Thomas Ozbolt
Well, there's meds that can reduce the recurrence. These are called anti-epileptic drugs or anticonvulsants. These will suppress the epileptic discharges from the brain or limit the spread of those discharges through the brain. So when we talked about that localized focus, spread into generalized, it can kind of, you know, almost nip it in the bud. And that's what we have right now.

0:16:04 - Shane Smith
So you have sort of mini, it, it hits one area but it doesn't spread everywhere. It's like a cage. Confines it to one area?

0:16:10 - Thomas Ozbolt
Right. You gotta just, you know, almost snuff it out, is almost the way you want to think about it. Now, most people's post-traumatic epilepsy can be controlled pretty effectively with these anticonvulsants, but there's a subset, the TBI cases, with up to 13% in one study, that are difficult to control, no matter which type of anti-epileptic drug that you have. Just really important in these situations, in any situation where you have a traumatic brain injury, to get connected with an experienced neurologist who cares about you and who's going to listen to you. And I think that really starts with, you know, getting a lawyer who's going to listen to you and advocate for you and try to get you the best treatment you can get in the world.

0:16:51 - Shane Smith
And you said the neurologist, who will really listen and care, care and try to help you. I think that's a key part here. Sometimes we think just any doctor, but you want an actual doctor. I'd say the best of the best doctors, right, the ones who have real bedside manner, who wanna listen to you and deal with this, which probably isn't just the nearest doctor to you.

0:17:05 - Thomas Ozbolt
Right. And especially, you think about a neurologist. 87% of the counties in the United States don't have a neurologist.

0:17:10 - Shane Smith
Right, we talked about that in a prior episode. They're just not there. So you're gonna have to have to travel to a big city, probably have to book a bunch of time, probably gonna have to test two or three to find one that works with you. You know what I mean, that you like and and you found genuinely cares to even begin this. But I think the fear is with the, the medicine, how do you know it's working?

0:17:32 - Thomas Ozbolt
You know it's working because you're having less of them. It's preventing their recurrence.

So you can, you can see that. Some of them are very effective. Again, that subset that it doesn't work for, you know you're obviously going to see, hey, it's just not going to work with these people. Good thing though you say, hey, you're gonna have to travel to see you know neurologists in many instances. But one of the really good things that we've talked about before is there are doctors all over the country who are doing incredible things with telemedicine at this point in time. Because when you're dealing with somebody who's suffering neurological symptoms, it's not always necessary for you to be able to touch and feel them, despite what you know the insurance industry wants to tell you is, "Oh, you got to see them in person." No, some of the most important things that can be done can be done over video, because it's looking at how somebody presents themselves physically. Wow and the eyewitness to everything else.

All that can be done telemedicine. The world's changing and that's making you know great health care accessible for everyone, and not just for people who live in a big city or who have millions of dollars to throw around to see whatever doctor.

0:18:35 - Shane Smith
And I think those are two of the key things that we can be most hopeful about. You know telemedicine, you can get treatment, like you say. I can live in rural areas and get a great doctor because they're there. Not that there aren't only great doctors in the city, but there just aren't enough neurologists. Right. So I can see one wherever they are right?

0:18:50 - Thomas Ozbolt
Right. See them in the comfort of your own home and your own environment. Some people, when they go to the doctor's office, their heart, their blood pressure, goes sky high. I have great blood pressure. When I go to the doctor's office, my blood pressure looks like I'm 65 years old and 600 pounds.

0:19:04 - Shane Smith
Yeah, it's bad. Yeah it's bad. So you don't have all those added stressors. The doctor can actually see you in your natural environment how you really are. Right. Which I think is huge, especially for brain injury clients, because they don't need added stress. I would imagine added stressors are more likely to cause a seizure than not having them.

0:19:21 - Thomas Ozbolt
You can see the environment that they live in, how their life is, what things are like around them. Right, it would give a whole picture a lot better, right? Right, because a picture inside of a doctor's office, that has limited value sometimes, I think.

0:19:35 - Shane Smith
All right, Thomas, thanks for being on the show today. I think we've learned a lot between last episode and this episode, talking about seizures and epilepsy and treatments and all the hope out there. For all of our listeners, if this topic is interesting to you, comment down below. Or if there's another topic you would like us to talk about one of our next episodes, please let us know. We'd be glad to delve into that for our listeners. Like and subscribe to see future episodes and remember, if you're in pain, call Shane 980-999-9999. If you've got a question for our concussion brain injury group, just give us a call and we'll get one of our lawyers to answer it.