The Military Injuries: Understanding Post-Traumatic Epilepsy Study: Understanding Relationships among Lifetime Traumatic Brain Injury History, Epilepsy, and Quality of Life
Mary Jo Pugh, Eamonn Kennedy, James J. Gugger, Jamie N. Mayo, David F. Tate, Alicia A. Swan, Jacob Kean, Hamada Altalib, Shaila Gowda, Alan R. Towne, Sidney R. Hinds, Anne Van Cott, Maria Lopez, Carlos A. Jaramillo, Blessen C. Eapen, Randall McCafferty, Martin Salinsky, Joyce A. Cramer, Katherine K. McMillan, Andrea Kalvesmaki, Ramon Diaz‐Arrastia, the MINUTE Study Group, Megan E. Amuan, Amy Henion, Silvia Padilla, Mary Katherine McCafferty, Barbara Elizondo, Margaret Wells
Abstract
Understanding risk for epilepsy among persons who sustain a mild (mTBI) traumatic brain injury (TBI) is crucial for effective intervention and prevention. However, mTBI is frequently undocumented or poorly documented in health records. Further, health records are non-continuous, such as when persons move through health systems (e.g., from Department of Defense to Veterans Affairs [VA] or between jobs in the civilian sector), making population-based assessments of this relationship challenging. Here, we introduce the MINUTE (Military INjuries—Understanding post-Traumatic Epilepsy) study, which integrates data from the Veterans Health Administration with self-report survey data for post-9/11 veterans ( n = 2603) with histories of TBI, epilepsy and controls without a history of TBI or epilepsy. This article describes the MINUTE study design, implementation, hypotheses, and initial results across four groups of interest for neurotrauma: 1) control; 2) epilepsy; 3) TBI; and 4) post-traumatic epilepsy (PTE). Using combined survey and health record data, we test hypotheses examining lifetime history of TBI and the differential impacts of TBI, epilepsy, and PTE on quality of life. The MINUTE study revealed high rates of undocumented lifetime TBIs among veterans with epilepsy who had no evidence of TBI in VA medical records. Further, worse physical functioning and health-related quality of life were found for persons with epilepsy + TBI compared to those with either epilepsy or TBI alone. This effect was not fully explained by TBI severity. These insights provide valuable opportunities to optimize the resilience, delivery of health services, and community reintegration of veterans with TBI and complex comorbidity.