Seizures following Traumatic Brain Injury

Brain Injury Blog by  Steven M. Gursten

June 15, 2012

Seizures following traumatic brain injury

How TBI causes post-traumatic seizures, and what TBI lawyers can do to better represent and protect their clients

It’s been all over the news that US Commerce Secretary John Bryson has been on medical leave after two hit-and-run car accidents. According to published reports, authorities found Bryson, 68, unconscious behind the wheel of his car after he hit one car and then hit another car minutes later. White House officials are saying he suffered a seizure.

We wish Secretary Bryson a speedy recovery.  However, what happened to Secretary Bryson is also instructive. The connection between TBI and seizure, especially after a traumatic event such as a car accident, is far more common than many people might realize.

I have a client who is being tested at U of M hospital for post-traumatic Parkinson’s and seizures following a traumatic brain injury (TBI) from a truck accident after he struck his head. This case,  as with Bryson’s, holds lessons for  brain injury lawyers about the relationship between TBI and  post-traumatic seizures.  My client had what was initially classified as a very “mild” traumatic brain injury. Mild is a medical classification, and it does not mean the impairments are  “mild” or that the consequences of brain injury for the accident victim are mild.  And, over the past year, my own client’s condition clearly deteriorated.

Crash victims having seizures or “spells” following a traumatic brain injury

Seizures can occur following mild traumatic brain injury (MTBI) and are often described as a form of “post-traumatic epilepsy” consisting of “partial seizure-like symptoms.”  Seizures usually indicates the brain is injured, especially when there is no history of seizures before a traumatic event.

My client’s brain injury started like most. The early medical records show the classic constellation of traumatic brain injury symptoms, such as headaches, dizziness, sleep disturbance and fatigue. The seizures came later.  At first, he wasn’t even aware he was having them. His wife was the first one to notice them.  She reported to the doctors that he was staring off.  Many only last a few seconds, but can include incontinence. Being told he was “staring off again” was terrifying for him.

Because of the gap of time between when he hit his head and when these seizures were first reported, his workers compensation carrier denied all payment as accident-related.  He was confused, scared, and being told he couldn’t even see a neurologist for these seizures because his insurance company was disputing any causal relationship.

Causes of epileptic seizures in auto accident victims with brain injury and MTBI

Seizures are a major complicating factor contributing to poor outcomes in the approximately “20 percent miserable minority” of people who have suffered brain injury. These are the people who do not make good recovery.  Many go on to have permanent disability. 

An abnormal electrical discharge in the brain causes brain injury seizures. 

I’ve learned from past cases, neurologist examinations and cross-examinations of defense IMEs that an epileptic seizure is caused by the inappropriate discharge of cerebral neurons as a result of brain dysfunction.

It sounds complicated, but in a normal brain, the spread of electrical activity between neurons is restricted. During a seizure, there is an abnormal discharge of electrical activity in the brain. The most noticeable form is a “general seizure,” where neurons throughout the entire brain are inappropriately activated.

Still, most post-traumatic seizures are known as “partial seizures” with a focal region of the brain with abnormal electrical discharge. I’ve been told that the partial seizures usually originate in the temporal lobe. The temporal lobe is the area of the brain that involves emotion, memory, sense of smell and hearing.  Seizures can affect each of these, and the medical records from my client show that each of these areas has been affected. 

What lawyers and TBI victims must know when seizures are present

The best advice I can give, as a brain injury lawyer for nearly 20 years, is that it’s imperative to have an experienced neurologist involved in your client’s care, recovery and rehabilitation.  

Sometimes these seizures will manifest themselves immediately or very close in time to the trauma, as what may have happened to Secretary Bryson.  Some seizures — especially the ones most often referred to as “spells”— may take weeks before they’re noticed, reported and documented.  As scary and disabling as partial-seizures can be, they are often missed and poorly documented in medical records. This happens because the “spells” are first noted by family, and because seizures are often   overshadowed by more obvious injuries, such as physical injuries.

In those cases, sadly, medico-legal issues become common, as when insurance companies deny payment and causation.  It certainly helps to have an experienced lawyer and neurologist who are familiar with the connection between traumatic brain injury and seizures to help people get the medical care and compensation they need.

Even the more mild-type seizures can be completely disabling.  My own client is still not allowed to drive and, as a professional truck driver, has been off work since his truck accident.  The workers compensation carrier is still disputing the injury, and the case is proceeding to trial. 

Steven M. Gursten is an experienced Michigan traumatic brain injury lawyer who serves on the executive board of the American Association for Justice Traumatic Brian Injury Litigation Group.  Steve is the current president of the Motor Vehicle Trial Lawyers Association.

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