Epidemiological Characterization and Prognostic Models for PTE: A Collaborative TBI-MS and VHA Study
Abstract
Epilepsy affects 1 in 26 Americans and is often a result of traumatic brain injury (TBI). In addition to the associated public health burden associated with civilian TBI, epilepsy is a significant concern for the U.S. Department of Defense (DoD) and Department of Veterans Affairs (VA), given the high number of service members who have suffered a TBI while deployed in support of the wars in Iraq and Afghanistan (post-9/11). About 20% of Veteran-related TBI is moderate to severe in nature, with about 60,000 cases identified between September 2001 and June 2015. Our team s work shows that the prevalence of epilepsy among Post-9/11 Veterans with penetrating TBI is about 10.6%. Our work also shows that the prevalence among civilians with TBI at 5 years post-injury is about 20.5%, underscoring the importance of studying risk factors for post-traumatic epilepsy (PTE) and its effects on TBI relevant outcomes. Health-related quality of life is often poor among individuals living with epilepsy, in part due to comorbid disease burden, including diseases related to mental health. Currently, there is virtually no literature evaluating the effects of epilepsy and comorbid conditions on outcome after TBI. The most common comorbid conditions associated with epilepsy in the general population are mood disorders, followed closely by anxiety. We have completed some preliminary work in a civilian cohort enrolled into the TBI Model Systems National Database (TBI-MS NDB) showing higher rates of depression and anxiety among individuals with PTE when compared to individuals without PTE. Our previous work also suggests that both Veterans and civilians with TBI have significant barriers to recovery and have limitations with multi-dimensional outcome including employment and other participation based outcomes. Together, these findings suggest a need to determine how the added burden of PTE coexists with mental health and cognitive symptoms and how they together influence TBI outcomes. We have also used the TBI-MS NDB to identify key risk factors for developing PTE. Using clinical and demographic data, we have been able to generate good prognostic models identifying discrete risk factors for PTE. However, we believe that personal biology, specifically genetic information, could contribute meaningful information regarding risk for PTE. In fact, we have data from our local civilian cohort showing that variation in neurobiologically relevant genes can add important information to PTE risk prediction. With this planning grant, we want to put key pieces in to place to study if/how personal biology further affects PTE risk and outcome. Scientific Goals: Based on these needs and our preliminary data, the primary goal of this epidemiology-focused planning grant is to generate needed prediction models and feasibility data that will support large scale efforts to generate PTE prognostic risk models for both Post-9/11 Veterans and civilians with TBI and to determine if/how mental health burden is higher among individuals with TBI and PTE compared to those with TBI and no PTE. We believe that there is additional mental health burden and cognitive dysfunction associated with PTE, and this burden further limits participation in social and other life roles after TBI. In conjunction with previous and current studies in our local civilian cohort, another primary goal is to establish the feasibility of using Veterans Health Administration (VHA) data and the Department of Defense Trauma Registry (DoDTR), along with genetic samples from Post-9/11 Veterans, wherein we generate accurate prognostic models for PTE risk and assess PTE risk effects on TBI outcomes. We will use the TBI-MS NDB to build prognostic risk and outcome models involving civilians with TBI. We also have access to several years of VHA and DoDTR data on Post-9/11 Veterans with moderate-to-severe TBI to complete the genetics pilot study proposed. No additional data collection is needed for analyses
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810736
Entities
People
- Amy K Wagner
Organizations
- United States Army
- University of Pittsburgh