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Good articlePost-traumatic epilepsy has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do so. If it no longer meets these criteria, you can reassess it.
Article milestones
DateProcessResult
August 2, 2008Good article nomineeListed
Did You Know
A fact from this article appeared on Wikipedia's Main Page in the "Did you know?" column on March 6, 2008.
The text of the entry was: Did you know ...that antiepileptic drugs have been shown to prevent early post-traumatic seizures but not post-traumatic epilepsy?

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The literature frequently uses "post-traumatic seizures" when referring to the chronic condition, maybe because it's broader (they definitely have seizures, but it's harder to diagnose epilepsy). I've been using PTE when a source says "seizure disorder" but when it just uses PTS, I've been putting it in the PTS article. delldot talk 22:18, 1 March 2008 (UTC)[reply]

Comments from Colin

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I'm copying these from my talk page so they're accessible to everyone. delldot talk 00:15, 4 March 2008 (UTC)[reply]

A bit of research

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Some sources on Google Books

  •  Done Yudofsky, Stuart C.; Silver, Jonathan M.; McAllister, Thomas G. (2005). Textbook Of Traumatic Brain Injury. Washington, DC: American Psychiatric Association. pp. 309–321. ISBN 1-58562-105-6.{{cite book}}: CS1 maint: multiple names: authors list (link)
Chapter 16 has a section on seizures.
  •  Done Swash, Michael (1998). Outcomes in neurological and neurosurgical disorders. Cambridge, UK: Cambridge University Press. p. 172. ISBN 0-521-44327-X.
  •  Done Dodson, W. Edwin; Giuliano Avanzini; Shorvon, Simon D.; Fish, David R.; Emilio Perucca (2004). The treatment of epilepsy. Oxford: Blackwell Science. pp. 775-. ISBN 0-632-06046-8.{{cite book}}: CS1 maint: multiple names: authors list (link)
Chapter 64: Surgery of Post-Traumatic Epilepsy
  •  Done Daniel L. Barrow (1992). Complications and sequelae of head injury. Park Ridge, Ill: American Association of Neurological Surgeons. pp. 127–132. ISBN 1-879284-00-6.
Chaptre 8: Post-Traumatic Epilepsy

Jennet's 1975 book ("Epilepsy after Non-Missile Injuries", 2nd Edition, 1975) appears to be the definitive work from which others are based. Its age means that some definitions may have been superseded. If you can get hold of this book, your articles would benefit immensely.

Temkin's 1990 study ("A randomized double-blind study of phenytoin for the prevention of post-traumatic seizures" N Engl J Med 323:497-502, 1990) seems to be the critical study into prophylaxis.

Jennet is responsible for the classification into early and late post-traumatic seizures, with the early form occurring with the first week. This definition still holds. Some have suggested a refinement to consider the first day as another threshold. Several sources state "One third of early seizures occur within the first hour of injury, another one-third within the first day, and the last one-third during the remainder of the first week"-- including bowen 1992 delldot talk 22:49, 6 March 2008 (UTC) [reply]

The Textbook Of Traumatic Brain Injury says "Technically, if seizures occur after the first week postinjury and are recurrent, the term post-traumatic epilepsy should be used, but the literature uses the terms posttraumatic seizures and posttraumatic epilepsy interchangeably, and most seem to favor the use of posttraumatic seizures.

I'd say we can classify post-traumatic seizures into two groups: early (within 7 days of injury) and late. The early group can be further subdivided such that immediate seizures occur within 24 hours of injury.

The issue is that if one has epilepsy, then one also has seizures. But one may have seizures without epilepsy (i.e., if they are provoked). It is safer for authors to use the term "seizures" since they are observable unambiguous events that may be counted and dated. The transition from saying "these seizures are caused by the original injury" (provoked) to "these seizures are due to the long-term brain damage" (unprovoked)" is the key to the use of the term "epilepsy". The "one week" threshold is, according to most, rather arbitrary. Your source for the provoked/unprovoked distinction is using the early=provoked late=unprovoked grouping in an approximate manner. They aren't directly equivalent due to the arbitrary nature of the 7 day cut-off.

  • Hauser WA, Annegers JF, Kurland LT (1991). "Prevalence of epilepsy in Rochester, Minnesota: 1940-1980". Epilepsia. 32 (4): 429–45. PMID 1868801.{{cite journal}}: CS1 maint: multiple names: authors list (link)
(not free) This is the definitive epidemiological study of epilepsy, and the one where the 5% figure comes from.
This reports that one study suggests even a single late seizure should be a strong indication to initiate antiepileptic drug treatment. A few people define epilepsy as a propensity to recurrent seizures rather than have a history of recurrent seizures. That would effectively diagnose these people with epilepsy due to the injury + one seizure.
This is your expert report you need to give current best-practice recommendations on prophylaxis. They recommend prophylactic treatment with phenytoin for one week in cases of severe TBI. They discourage the routing use after 7 days, and make no recommendation for mild to moderate TBI. The paper also contains useful stats.
Written after Temkin's 1990 study, this confirms the tradition of one year of prophylaxis but recommends only one week.
Written between Jennet and Temkin, this is somewhat dated. The stats on 7000 PTE cases per year in Britain are interesting. Without the benefit of later studies, the author's repeat a claim that "100,000 Americans develop epilepsy each year because they have not been given prophylactic anticonvulsants" and suggest it is "prudent to continue [anticonvulsants] for at least two years, after which the drug should be tailed off slowly".
This article contains an interesting quote from Wilder Penfield that the gap between injury and seizure is "a silent period of strange ripening". Might be worth repeating that.
This paper by Jennett predates his 1975 book. The early/late distinction (one week) is present even then. He uses the word "epilepsy" in a way that wouldn't be allowed now (for example, to describe a single generalised convulsion one minute after injury). Epilepsy by definition is not provoked and must be recurrent. I think Jennett is the origin of the misuse of seizures/epilepsy terms. Many later author's have preferred to say "seizures" rather than use his words, leading to a mix of usage.

Colin 13:41, 25 February 2008 (UTC) (posted to User talk:Delldot)[reply]

The sources marked  Done I've already fully read. delldot talk 00:15, 4 March 2008 (UTC)[reply]

GA Review

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This review is transcluded from Talk:Post-traumatic epilepsy/GA1. The edit link for this section can be used to add comments to the review.

Some comments as I go along reading this important article:

  • Intro: Does the intro need to contain so much information about the nomenclature of PTS vs PTE? Could this be moved to the article body ("Definition" section), with only a very basic definition remaining? JFW | T@lk 08:29, 25 July 2008 (UTC)[reply]
  • Some added, I can add more if you think it's a good idea. Oddly, I've been told in other articles that there's too much referencing in the lead and that the lead needs few or no refs because it's a summary of content referenced in the article. Personally, I'm more in favor of erring on the side of too much referencing though. delldot talk 15:55, 25 July 2008 (UTC)[reply]
  • Hmm. A single reference should be available for each statement. If that isn't possible then usually the statement is not suitable for the lead :-). JFW | T@lk 16:47, 25 July 2008 (UTC)[reply]
  • I don't know if I'm going to be able to find something that has all the points covered, so far a look through the reviews I've already used hasn't produced anything. I'll keep my eye out though. delldot talk 17:40, 28 July 2008 (UTC)[reply]
  • It doesn't really discuss signs and symptoms though, I'm not sure what the right name for this section could be. I could take the onset out and merge with some info from prognosis into a "Timing" section or something. The focal and generalized info could go into classification. delldot talk 15:55, 25 July 2008 (UTC)[reply]
  • I'd say a seizure is a symptom... There is going to be some content that could go either in this section or in the prognosis/epidemiology sections. JFW | T@lk 16:47, 25 July 2008 (UTC)[reply]
  • Maybe not, but I would like to keep the info on onset somewhere in the article since it's discussed in a lot of sources and it looks like an important area of study. Should it be incorporated into a "Timing" section or stuck into some other section? I don't know whether it would fit under prognosis: the question is how likely a person is to get PTE after a TBI and how much later. delldot talk 15:55, 25 July 2008 (UTC)[reply]
  • It's under "Prognosis" now, I couldn't figure out where else to put it. I'm not sure if this is a logical place since it's got more to do with the prognosis of the TBI than the PTE. I can move it somewhere else if necessary. delldot talk 06:03, 26 July 2008 (UTC)[reply]
  • Changed to At least 80–90% of people with PTE have their first seizure within two years of the TBI. -- is this clearer?
  • Pathophysiology: Section would benefit from some clarification of difficult terms (e.g. "excitotoxicity", "neurotransmitter"). Is there a secondary source that enumerates the different theories? What is the etymology of "kindling" in "kindling theory"? JFW | T@lk 12:40, 25 July 2008 (UTC)[reply]
  • Diagnosis: is CT actually used if MRI not diagnostic? Counter-intuitive, as MRI gives much higher definition. Sometimes CT is used if MRI shows a lesion that can't be determined, but if there is no lesion then CT is a waste of time. IMHO. Anyway. JFW | T@lk 12:40, 25 July 2008 (UTC)[reply]
  • Whoops, yeah, didn't mean to imply CT would be more accurate. Rearranged wording to "CT scanning can be used to detect brain lesions if MRI is unavailable" certainly availability, not sensitivity, would be the reason for CT. delldot talk 15:13, 25 July 2008 (UTC)[reply]
  • Diagnosis: do the sources make any mention of alternative causes for seizures after a head injury, such as medication use, metabolic disturbances (low sodium)? These may lead to seizures in any hospitalised patient without necessarily indicating a chronic seizure disorder. JFW | T@lk 12:40, 25 July 2008 (UTC)[reply]
  • I've added level 4 headers, and I like how these break up the text more, but that still leaves a single level 3. Alternately I could do away with all the level 4's and the level 3, or create a separate level 2 for risk factors. delldot talk 23:20, 27 July 2008 (UTC)[reply]

I will stop now, but hopefully I can carry on later on today. JFW | T@lk 08:29, 25 July 2008 (UTC)[reply]

 Done Have dome some copyediting myself and may come back to do some more. I'm sure there will be more comments after the above. JFW | T@lk 12:40, 25 July 2008 (UTC)[reply]
Sounds good, thanks so much for the thorough review and the work you've put in! I'll get to work on these today. delldot talk 15:13, 25 July 2008 (UTC)[reply]
By all means give me a yelp when you're done. I can then offer further comments or decide to promote :-). JFW | T@lk 15:41, 25 July 2008 (UTC)[reply]
Sounds good. Have to go now but I'll get back to work on these as soon as I can. Thanks for the great suggestions, sorry for the lackluster response. delldot talk 15:55, 25 July 2008 (UTC)[reply]
If this is a lacklustre response then I'm Jabba the Hutt. JFW | T@lk 16:47, 25 July 2008 (UTC)[reply]
Don't eat me! :P I'll keep working, but progress will likely be slow till after Monday. delldot talk 06:13, 26 July 2008 (UTC)[reply]
That's fine. I won't eat you. JFW | T@lk 07:23, 27 July 2008 (UTC)[reply]

Part II

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Some further comments in anticipation of GA approval:

  • Classification: is there any way to generalise about the classification about PTS/PTE any further? The section appears to contradict itself a few times, if only because it calls on different sources. Has there been a consensus of any form? If there is, then perhaps more emphasis on this consensus is needed. JFW | T@lk 10:01, 29 July 2008 (UTC)[reply]
  • Yeah, it's not actually nearly as complicated as I had made it sound: it's unprovoked that matters, timing is just a way to judge that. Hopefully the changes I made clear this up. I also added some info on the controversy over whether to diagnose PTE after one seizure or to require more than one. I can't find any consensus statement though, but that would be nice. delldot talk 17:36, 31 July 2008 (UTC)[reply]
  • Actually I was trying to say that having head trauma doesn't protect you from seizures with other causes (e.g. metabolic), so seizures may not necessarily be due to TBI even in a TBI survivor (i.e. a diagnosis of PTE shouldn't be made just because a seizure occurs in a TBI survivor). Reworded, is this clearer? delldot talk 15:14, 29 July 2008 (UTC)[reply]
  • It's weird, I can't find that info again in the source (possibly because there are a couple pages I can't see in Google books). And I can't find it anywhere else either. I've taken it out. delldot talk 17:12, 31 July 2008 (UTC)[reply]
  • Epidemiology: different statistics are quoted from different sources wrt the incidence of PTE after mild/moderate/severe head injury. A case for grouping all the figures somewhere? JFW | T@lk 10:01, 29 July 2008 (UTC)[reply]
  • The best definition I could come up with for standardized incidence ratio was "a great deal of scary math stuff", but that was 7 words. Luckily, the original study had it in regular English too, so reworded in the article and changed the citation. delldot talk 20:24, 29 July 2008 (UTC)[reply]
  • Epidemiology: the numbers cited to Pitkänen et al are surely from a primary research study - perhaps add a direct reference to that study as well? JFW | T@lk 10:01, 29 July 2008 (UTC)[reply]

That should be about it... JFW | T@lk 10:01, 29 July 2008 (UTC)[reply]

I've begun working, but progress will likely still be slow. delldot talk 15:14, 29 July 2008 (UTC)[reply]

Great stuff so far. Let me know when I can give this fine article the Green Blob. JFW | T@lk 15:22, 29 July 2008 (UTC)[reply]

I think I've addressed everything, let me know if I missed any. delldot talk 12:08, 1 August 2008 (UTC)[reply]

GA done. Good. JFW | T@lk 21:46, 2 August 2008 (UTC)[reply]

Classification

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From the ILAE:

  • checkYPartial (or Focal) – involves only part of one hemisphere of the brain. (or, more simply, involves only part of the brain)
  • checkYGeneralised – involves both hemispheres of the brain.

A few comments on classification:

  • checkYThe text on partial, "therefore part of the body", is too simplistic and assumes motor signs. A partial seizure might instead affect the senses, the autonomic nervous system, or the mind.
  • checkYThe text on generalised, "leading to convulsions of the entire body", isn't always the case, as there are many other effects of generalised seizures and convulsions do not always occur. The "loss of consciousness" is correct, though it can be brief.
  • checkY"they may have a focal onset and then proceed to affect the entire body (a phenomenon known as "secondary generalization")" This uses the word "focal" without informing the reader that it is synonym for partial. It repeats the "entire body" (see point above). It might be simpler to just say that sometimes generalised seizures begin as partial seizures, which spread. The reader of this article probably doesn't need to have "secondary generalization" defined, unless you intend to use it again (e.g., in the epidemiology).
  • checkY"while partial seizures increase in prevalence as time passes after the injury" might be read to mean they become more common/frequent with time rather than become the more common form of seizure.

I would offer to revise the text here but it is getting late for me tonight, and I'd have to use different sources from yours. Colin°Talk 21:31, 26 July 2008 (UTC)[reply]

Thanks much for the accuracy check Colin, I think these are fixed now. About the last point, neither the ref cited or the paper it cites is clear on which meaning: "[complex partial] and [partial with generalization] seizures are most common after the first week", says Barry E, Bergey GK, Krumholz A; et al. (1997). "Posttraumatic seizure types vary with the interval after head injury". Epilepsia. 38 (Supplement 8): 49S–50S. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
Reading that, it looks like this info has more relevance to post-traumatic seizure anyway, since it's mainly covering the first week after TBI, so I'm going to take this info out.
Thanks again, your feedback is always most welcome. delldot talk 23:56, 26 July 2008 (UTC)[reply]

GA done. Congratulations. JFW | T@lk 21:45, 2 August 2008 (UTC)[reply]


Image

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This article could use an image in the lead. Not sure what but... Doc James (talk · contribs · email) 03:02, 19 December 2009 (UTC)[reply]

Jennett's work

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Chokseym added the following:


This may be true, except this is written in Wikipedia's voice without a source. I am sure that it is correct, but we cannot say it without a WP:MEDRS-compatible secondary source. JFW | T@lk 17:08, 25 February 2014 (UTC)[reply]

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