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The Prevalence of Epilepsy and Association With Traumatic Brain Injury in Veterans of the Afghanistan and Iraq Wars

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

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP

Journal of Head Trauma Rehabilitation: January/February 2015 - Volume 30 - Issue 1 - p 29–37
doi: 10.1097/HTR.0000000000000045
Original Articles

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.

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South Texas Veterans Health Care System (VERDICT), San Antonio (Drs Pugh and McMillan); Department of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio (Drs Pugh, Orman, and McMillan); Department of Medicine, Texas A&M University School of Medicine (Dr Pugh); Statistics and Epidemiology US Army Institute of Surgical Research, Fort Sam, Houston, Texas and University of Texas School of Public Health, San Antonio Regional Campus, San Antonio (Dr Orman); Department of Rehabilitation Medicine, Polytrauma Rehabilitation Center South Texas Veterans Health Care System (STVHCS), U.T. Health Science Center San Antonio, San Antonio (Drs Jaramillo and Eapen); Portland Veterans Affairs Medical Center, Portland, Oregon (Dr Salinsky); Oregon Health & Sciences University, Portland (Dr Salinsky); Epidemiology and Community Health, Virginia Commonwealth University, Richmond (Dr Towne); Epilepsy Center of Excellence, McGuire Veterans Administration Hospital, Richmond, Virginia (Dr Towne); Edith Nourse Rogers Memorial Hospital (The Center for Health Quality, Outcomes and Economic Research [CHQOER]), Bedford, Massachusetts (Dr Amuan); Nantz National Alzheimer Center, Methodist Neurological Institute, Houston, Texas (Dr Roman); Physical Medicine & Rehabilitation Service, Hunter Holmes McGuire Veterans Administration Hospital, Richmond, Virginia (Dr McNamee); Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas (Dr Kent); Baylor College of Medicine, Houston, Texas (Dr Kent); West Haven VA Medical Center, West Haven, Connecticut (Dr Hamid); and Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, Illinois (Dr Grafman).

Corresponding Author: Mary Jo V. Pugh, PhD, South Texas Veterans Health Care System (ALMD), 7400 Merton Minter Blvd (11C6), San Antonio, TX 78229 (

Findings were presented at the American Academy of Neurology in April 2012 and VA HSR&D Annual Research Meeting in July 2012.

The study was funded by VA Health Services Research and Development (DHI 09-237). Administrative, technical, or material support was provided by Kathleen Franklin, South Texas Veterans Healthcare System. Data analysis was conducted by Ms Amuan.

The content of this article is solely the responsibility of the authors and does not necessarily reflect the official views of the Veterans' Health Administration. The funding organizations had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript. The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

The authors declare no conflicts of interest.

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