Post-Traumatic Epilepsy: Cognitive and Neurobehavioral Characteristics (PTE-CNBC) Among Post-9/11 US War Veterans
Abstract
Scientific Rationale: Post-traumatic epilepsy (PTE) refers to epilepsy that develops after traumatic brain injury (TBI). An investigation by the Department of Defense (DoD) in 2013 reported that 8% of the active duty Service members diagnosed with new onset epilepsy had a previously diagnosed TBI. This is a significant concern for the 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). A previous study by Pugh et al., in 2015 examined the association between TBI and epilepsy in a large cohort of Post-9/11 Veterans and found that even individuals with mild TBI (mTBI) were highly likely to be diagnosed and treated for epilepsy compared to Veterans without TBI. Because the majority of TBI are mild, even a slightly elevated risk of PTE following mTBI could substantially increase the burden on these individuals. What are those burdens? PTE after TBI may act as a “second hit” on a brain that is already vulnerable to the development of various neurological deficits and disabilities due to TBI. This further can accelerate their cognitive and behavioral ageing in addition to the other clinical conditions that arise from epilepsy and TBI. This may profoundly affect the lives of these young Veterans, their families, and the healthcare systems on which they depend for care. Why do we need to identify cognitive and behavioral symptoms, their patterns or phenotypes in PTE? Previous reports suggest that PTE may negatively influence the functional and behavioral outcome of patients with severe TBI. But very few civilian and no Veteran studies have examined this association among those with mTBI. Distinguishing healthy cognitive and behavioral aging from accelerated decline has important implications on diagnosis and treatment. Combining neuropsychological test data and neuroimaging data with the demographic and clinical data can improve our ability to identify subgroups representative of distinct cognitive and behavioral symptoms. This can also aid in better understanding of the bidirectional relationship between epilepsy and cognitive and behavioral impairments. This study proposes to abstract cognitive and behavioral symptom data from neuropsychological test reports and link them to VA administrative data to identify neurobehavioral phenotypes among the study population. Scientific Objective: The proposed study will leverage data from an existing DoD-funded PTE study (W81XWH-16-2-0046) that is examining the relationship between mTBI and epilepsy in deployed Post-9/11 Veterans. From this PTE study, we will identify Veterans with new onset epilepsy after mTBI and those with mTBI or epilepsy alone. Then we will review their clinical documents (such as clinician notes, test records, imaging reports, etc.) to identify various symptoms related to cognition (such as memory, learning, understanding, reasoning, etc.) and symptoms related to behavior (such as aggression, irritability, depressive mood, personality disorders, etc.). We will then describe how often these symptoms occurs in the study groups and also describe the patterns (neurobehavioral phenotypes) of these symptoms in the study population using statistical analysis. Finally, we will merge this data with the demographic and comorbidity data; and for those with mTBI, the data from their comprehensive TBI evaluation, to examine the factors associated with these phenotypes. As a result, with a small investment we will be able to identify specific phenotypes of cognition and behavior in Veterans with epilepsy and mTBI and be able to determine if those patterns are different among individuals who have an epilepsy after mTBI. We will also abstract the word concepts from the medical records that patients or clinicians use to describe these cognitive and behavioral symptoms. We will input these into a computer program that can be used
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010631
Entities
People
- Jamie N Mayo
Organizations
- United States Army
- University of Utah