Posts Tagged Traumatic Brain Injury

[WEB PAGE] Rehabilitation After Traumatic Brain Injury – Johns Hopkins Medicine

Traumatic brain injury (TBI) occurs when a sudden injury causes damage to your brain. A “closed head injury” may cause brain damage if something hits your head hard but doesn’t break through your skull. A “penetrating head injury” occurs when an object breaks through your skull and enters your brain.

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Symptoms that may occur after TBI may include:

  • Headaches
  • Dizziness
  • Confusion
  • Convulsions
  • Loss of coordination
  • Slurred speech
  • Poor concentration
  • Memory problems
  • Personality changes

According to the CDC, the leading cause of TBI is falls, particularly for young children and adults over 65. Other common causes of TBI include accidental blunt force trauma, motor vehicle accidents, and violent assaults.

If you have had a TBI, rehabilitation (or rehab) will be an important part of your recovery. Rehab can take many forms depending on your needs, and might include physical, occupational, and speech therapy, as well as psychiatric care and social support. All of these are designed to help you recover from the effects of your injury as much as possible.

Why might I need rehab after traumatic brain injury?

Rehab may help:

  • Improve your ability to function at home and in your community
  • Help treat the mental and physical problems caused by TBI
  • Provide social and emotional support
  • Help you adapt to changes as they occur during your recovery

Rehab can also help prevent complications of TBI such as:

  • Blood clots
  • Pain
  • Pressure ulcers, also called bedsores
  • Breathing problems and pneumonia
  • A drop in blood pressure when you move around
  • Muscle weakness and muscle spasm
  • Bowel and bladder problems
  • Reproductive and sexual function problems

What are the risks of rehab after traumatic brain injury?

Rehab after a TBI is not likely to cause problems. But there is always a risk that parts of treatment such as physical or occupational therapy might lead to new injuries or make existing symptoms or injuries worse if not done properly.

That’s why it is important to work closely with your rehab specialist who will take steps to help prevent problems. But they may still happen. Be sure to discuss any concerns with your healthcare provider before rehab.

How do I get ready for rehab after traumatic brain injury?

Before you can start rehab, you must get care and treatment for the early effects of TBI. This might include:

  • Emergency treatment for head and any other injuries
  • Intensive care treatment
  • Surgery to repair brain or skull injuries
  • Recovery in the hospital
  • Transfer to a rehabilitation hospital

What happens during rehab after traumatic brain injury?

Every person’s needs and abilities after TBI are different. You will have a rehab program designed especially for you. Your program is likely to involve many types of healthcare providers. It’s important to have one central person you can talk to. This person is often called your case coordinator.

Over time, your program will likely change as your needs and abilities change.

Rehab can take place in various settings. You, your case coordinator, and your family should pick the setting that works best for you. Possible settings include:

  • Inpatient rehab hospital
  • Outpatient rehab hospital
  • Home-based rehab
  • A comprehensive day program
  • An independent living center

Your individual program may include any or all of these treatments:

  • Physical therapy
  • Physical medicine
  • Occupational therapy
  • Psychiatric care
  • Psychological care
  • Speech and language therapy
  • Social support

You have many options for rehab therapy, and the type of rehab therapy that you need will be determined by your care team. Your care team will assess your needs and abilities. This assessment may include:

  • Bowel and bladder control
  • Speech ability
  • Swallowing ability
  • Strength and coordination
  • Ability to understand language
  • Mental and behavioral state
  • Social support needs

What happens after rehab for traumatic brain injury?

How long your rehab lasts and how much follow-up care you will need afterwards depends on how severe your brain damage was and how well you respond to therapy. Some people may be able to return to the same level of ability they had before TBI. Others need lifetime care.

Some long-term effects of TBI can show up years later. You may be at higher risk long-term for problems such as Parkinson disease, Alzheimer disease, and other forms of dementia.

After rehab you may be given these instructions:

  • Symptoms and signs that you should call your healthcare provider about
  • Symptoms and signs that are to be expected
  • Advice on safety and self-care
  • Advice on alcohol and drug use
  • Community support resources available to you

Your primary care provider should be given all the records and recommendations from your therapy team to help ensure that you continue to get the right care.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

via Rehabilitation After Traumatic Brain Injury | Johns Hopkins Medicine

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[ARTICLE] Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE): A pilot clinical trial for chronic traumatic brain injury – Full Text

Abstract

BACKGROUND:

Virtual reality (VR) technology may provide an effective means to integrate cognitive and functional approaches to TBI rehabilitation. However, little is known about the effectiveness of VR rehabilitation for TBI-related cognitive deficits. In response to these clinical and research gaps, we developed Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE), an intervention designed to improve cognitive performance, driving safety, and neurobehavioral symptoms.

OBJECTIVE:

This pilot clinical trial was conducted to examine feasibility and preliminary efficacy of NeuroDRIVE for rehabilitation of chronic TBI.

METHODS:

Eleven participants who received the intervention were compared to six wait-listed participants on driving abilities, cognitive performance, and neurobehavioral symptoms.

RESULTS:

The NeuroDRIVE intervention was associated with significant improvements in working memory and visual search/selective attention— two cognitive skills that represented a primary focus of the intervention. By comparison, no significant changes were observed in untrained cognitive areas, neurobehavioral symptoms, or driving skills.

CONCLUSIONS:

Results suggest that immersive virtual environments can provide a valuable and engaging means to achieve some cognitive rehabilitation goals, particularly when these goals are closely matched to the VR training exercises. However, additional research is needed to augment our understanding of rehabilitation for driving skills, cognitive performance, and neurobehavioral symptoms in chronic TBI.

1. Introduction

Each year, emergency departments treat approximately 2.5 million traumatic brain injuries (TBIs) (). TBI can affect a wide range of brain systems, resulting in sensorimotor deficits (e.g., coordination, visual perception), cognitive deficits (e.g., memory, attention), emotional dysregulation (e.g., irritability, depression), and somatic symptoms (e.g., headache, fatigue) (). These TBI-related impairments can have significant life consequences. Studies conducted across a wide range of neurological and psychiatric conditions show that neuropsychological abilities are strongly associated with functional skills and employment outcomes (). For example, challenges in attention and concentration could result in distractibility and errors in work settings, and deficits in executive functions could lead to poor organization and problems with setting and achieving occupational goals. As many as 3.2–5.3 million people in the US are living with TBI-related disability ().

Rehabilitation has been shown to improve outcomes for those experiencing chronic effects of TBI (). Previously-validated rehabilitation approaches for TBI include both ‘cognitive’ and ‘functional’ approaches. ‘Cognitive’ methods of rehabilitation are focused on improving performance on individual cognitive tasks, with the hope that these gains will generalize to functional activities (). Restorative cognitive training approaches have been shown to improve cognitive functioning across multiple conditions such as schizophrenia, traumatic brain injury, and normal aging (). Some of the most promising results to date have been demonstrated for training of attention and working memory, which have been shown to correspond to changes in functional brain activity (). Evidence suggests that the format of therapist-guided rehabilitation is able to harness some of the well-established benefits of the therapeutic relationship, and may be preferable to computer-guided training (). While there is some evidence indicating that benefits of cognitive remediation extend to untrained tasks, a number of studies have shown that improvements in performance on individual cognitive tasks tend to generalize very weakly, if at all, to other cognitive tasks and functional abilities (). This weak transfer of training might be attributable to low levels of correspondence between the cognitive and sensorimotor demands of rehabilitation tasks and those encountered during challenging real-world situations.

In contrast to methods of rehabilitation that rely upon generalization of cognitive benefits to functional outcomes, ‘functional’ methods of rehabilitation focus on improving performance on real-life activities through direct practice of those activities (). This approach requires effective targeting of specific functional tasks that are relevant to each patient and may be limited by the physical environments available within the treatment setting (e.g., a simulated home environment used to practice activities of daily living). However, the basic functional tasks that are often emphasized in functional rehabilitation (e.g., self-care, food preparation) may not be sufficiently challenging to address more subtle or ‘higher order’ cognitive and functional deficits that many mild to moderate TBI patients experience in the long-term phase of recovery ().

Virtual reality (VR) technology may provide an effective means to integrate cognitive and functional approaches to TBI rehabilitation (). The guiding concept for VR rehabilitation is to provide an immersive, engaging, and realistic environment in which to practice cognitive, sensorimotor, and functional skills. VR scenarios can simulate a wide range of real or imagined tasks and environments. While VR may not be necessary for tasks that are easily recreated in existing therapy environments, it is particularly well-suited for tasks that are challenging or dangerous to recreate within real-world treatment environments, such as driving an automobile ().

Driving is one of the most universal, cognitively challenging, and potentially-dangerous activities of everyday life. Safe driving requires continuous synchronization of processes like reaction time, visuo-spatial skills, attention, executive function, and planning (). Whereas it would be obviously unsafe to place an impaired patient into many real-world driving situations, VR allows for safe assessment and rehabilitation of driving-relevant skills at the true limits of the individual’s current capabilities. Individuals with TBI are at elevated risk for motor vehicle accidents and other driving difficulties (). Many individuals with severe TBI never return to driving (), and an estimated 63% of those with severe TBI who do return to driving are involved in motor vehicle accidents (). Available evidence suggests that deficits in attention and visual search may underlie these driving impairments. While most of this research has been conducted with moderate-to-severe TBI populations, these issues are not exclusive to severe forms of TBI. Individuals recovering from mild TBI have also been found to exhibit slower detection of driving hazards in simulated driving experiments () and to be at increased risk for real-world motor vehicle accidents ().

Previous results suggest that VR driving rehabilitation can be effective for improving driving skills among those with moderate-to-severe TBI (). However, these findings have not been replicated or validated for those with symptomatic mild TBI. Additionally, little is known about the effectiveness of VR rehabilitation programs for TBI-related cognitive deficits (). In response to these clinical and research gaps, we developed an intervention known as Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE), which was designed to improve cognitive performance and overall driving safety by providing integrated training in these skills. In contrast to intervention approaches that are geared toward more severely impaired individuals, NeuroDRIVE was designed for use with a wide range of TBI patients (i.e., mild, moderate, or severe TBI) who are seeking treatment in these areas and have the capability to engage in the driving process. This pilot clinical trial examined feasibility and preliminary efficacy of NeuroDRIVE for improving VR driving performance, cognitive performance, and symptom outcomes among those with chronic TBI. Given the focus of the intervention, effects on attention and working memory were of particular interest. Additionally, we have provided the NeuroDRIVE treatment manual as a supplementary document to facilitate continued development of VR rehabilitation for those with TBI.

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Continue —-> Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE): A pilot clinical trial for chronic traumatic brain injury

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Fig.2
T3 VR Driving Simulator.

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[VIDEO] Traumatic Brain Injuries: Effects of damage to different lobes of the brain – YouTube

http://www.ericratinoff.com Brain Injury Attorney Eric Ratinoff talks about traumatic brain injury – an area of personal injury he is proud to represent. He is always looking for opportunities to learn and share education on this topic, and he has created this video podcast on the areas of the brain and how they are affected by injury. Areas of the brain discussed are the frontal lobe, parietal lobe, occipital lobe, temporal lobe, cerebellum and brain stem. For more information about Traumatic Brain Injury, visit our online TBI Resource Center at http://www.ericratinoff.com/personal-…

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[VIDEO] Traumatic Brain Injury and Neurofeedback – YouTube

A video about Traumatic Brain Injury and Neurofeedback

 

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[ARTICLE] Functional Medicine Approach to Traumatic Brain Injury – Full Text

Abstract

Background: The U.S. military has seen dramatic increases in traumatic brain injuries (TBIs) among military personnel due to the nature of modern-day conflicts. Conventional TBI treatment for secondary brain injuries has suboptimal success rates, and patients, families, and healthcare professionals are increasingly turning to alternative medicine treatments.

Objective: Effective treatments for the secondary injury cascades that occur after an initial brain trauma are unclear at this time. The goal of successful treatment options for secondary TBI injuries is to reduce oxidative stress, excitotoxicity, and inflammation while supporting mitochondrial functions and repair of membranes, synapses, and axons.

Intervention: A new paradigm of medical care, known as functional medicine, is increasing in popularity and acceptance. Functional medicine combines conventional treatment methods with complementary, genetic, holistic, and nutritional therapies. The approach is to assess the patient as a whole person, taking into account the interconnectedness of the body and its unique reaction to disease, injury, and illness while working to restore balance and optimal health. Functional medicine treatment recommendations often include the use of acupuncture, Ayurveda, chiropractic manipulation, detoxification programs, herbal and homeopathic supplements, specialized diets, massage, meditation and mindfulness practices, neurobiofeedback, nutritional supplements, t’ai chi, and yoga. At present, some of these alternative treatments appear to be beneficial, but more research is needed to validate reported outcomes.

Conclusions: Few clinical studies validate the effectiveness of alternative therapies for TBIs. However, further clinical trials and empirical studies warrant further investigation based on some reported positive results from research studies, case histories, anecdotal evidence, and widespread popularity of some approaches. To date, only nutritional therapies and hyperbaric oxygen therapy have shown the most promise and potential for improved outcomes for the treatment of secondary TBI injuries.

Introduction

The u.s. military has seen a dramatic increase in traumatic brain injuries (TBIs) among military personnel during conflicts in recent years. According to estimates by the Department of Defense (DoD) and the Defense and Veteran’s Brain Injury Center, the majority of military TBIs are sustained during motor vehicle accidents, gunshot wounds, blasts, or a combination of these. An estimated 22% of all combat casualties are thought to be caused directly by TBIs. Compared to civilian populations, veterans are disabled for longer periods of time with symptoms of cognitive and behavioral impairments. Veterans frequently experience additional symptoms of post-traumatic stress disorder (PTSD) and chronic pain, and are at increased risk for suicide and substance abuse.

When the brain is injured, brain metabolism is altered and neurons are highly susceptible to damage from free radicals and mitochondrial dysfunction. Thus begins a pathologic process that can sometimes take years to repair. Conventional TBI treatment for these secondary brain injuries has had suboptimal success rates. Because of this, TBI victims, their families, and some healthcare professionals are increasingly exploring new treatment options that are perceived to be less injurious to health, more beneficial, and sometimes their only hope. As Joel Goldstein—whose son sustained a severe TBI in an automobile accident—the founder of the Bart Foundation, and author of No Stone Unturned: A Father’s Memoir of His Son’s Encounter with Traumatic Brain Injury—states: “Unconventional therapies are not merely a reasonable option, they are a necessity.” These “new” treatments include cell-based, genetic, holistic, integrative, nutritional, and hyperbaric oxygen therapies. Emerging treatment options for the treatment of secondary brain injuries is the focus of this article.

A literature review of alternative treatment options for patients with TBI was completed for this article with a focus on research reported between the years 1980 and 2017. Search criteria included TBI in the military; alternative and functional medicine therapies for brain injury; blogs and foundations for patients with TBI; and supplements, nutrition, and alternative therapies for the treatment of TBI. Because there are few clinical studies validating the effectiveness of alternative treatments for TBIs to date, promising therapies were selected for discussion based on reported objective evidence found in research settings, subjective therapies reported by patients with TBI and their families, and subjective clinician case reports.

Numerous clinical studies involving individual nutrients for brain injury treatment in animal models was found and 10 articles summarizing the most prominent of these studies were focused on. The Institute of Medicine (IOM) book about nutrition and TBI was also relied upon for a summary of research in this area. Three specific case reports are highlighted in this article because they represent the most successful alternative treatment approaches for patients with TBI to date. The Brain Trauma Foundation, Brain Health Education and Research Institute, Brainline.orgTraumaticBrainInjuryatoz.org, the National Center for PTSD [post-traumatic stress disorder], and Harch Hyperbarics also supplied information about therapies and treatments that patients with TBI and their families are finding helpful for recovery.

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Continue —-> Functional Medicine Approach to Traumatic Brain Injury

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[VIDEO] Cognitive and Psychological Consequences of Traumatic Brain Injury (TBI) – YouTube

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[WEB SITE] Nutritional Therapies for Traumatic Brain Injury

A change in diet might alleviate some of the long term symptoms of TBI.

Posted Dec 22, 2017

 

You have just experienced a traumatic injury to your head; a series of changes are about to occur in your brain that will have short and long term negative consequences.  You just joined the ranks of 1.7 million other people living in the U.S. who experience a traumatic brain injury (TBI) every year.  TBI is an alteration of brain function caused by external forces leading to loss of consciousness, temporary memory loss and alterations in mental state at the time of the injury.  

 

A study by the Mayo Clinic found that one-third of patients’ brains showing pathology and evidence of chronic degenerative diseases had participated in contact sports. The popular press has carried numerous stories about retired players of the National Football League who have a threefold increase in their risk of developing depression as well as a variety of worsening cognitive impairments.  Indeed, all athletes, especially young adults, exposed to repetitive concussions are at increased risk of developing cognitive deficits.

In the hours, days and weeks following initial accident a series of secondary biochemical changes develop that lead to a progressive degeneration within vulnerable brain regions. Many of these changes are also commonly seen associated with advanced normal aging and are thus rather well studied.  One of the initial changes involves a dysfunction of the mitochondria inside of the neurons of the brain.  Mitochondrial are responsible for energy production and are critical to the survival of neurons, which use a lot of energy. The injury to the mitochondria leads to a condition called oxidative stress where individual atoms of oxygen that we inhale become very toxic to the brain. Next, the oxidative stress induces brain inflammation which leads to an assortment of degenerative diseases, particularly during the years following the TBI event.  These three critical events following the TBI, i.e. loss of normal energy production, oxidative stress and long term brain inflammation, underlies the development of seizures, sleep disruption, fatigue, depression, impulsivity, irritability and cognitive decline. Although no effective treatments are available to alleviate these biochemical events in the brain, research has advanced sufficiently to understand how specific chemicals in the diet can target the negative effects of oxidative stress and inflammation.

A series of recent studies (Nutritional Neuroscience 2018, 21:79), conducted primarily using animal models, have discovered that adding certain vitamins and minerals to the diet might alleviate some of the long term consequences of TBI. I would never recommend taking mega-doses of any supplement, thus I have listed the dietary sources of these nutrients.  It is always most effective, and considerably cheaper, to obtain nutrients via their natural sources.  Supplementation with Vitamins B3 (found in white meat from turkey, chicken and tuna), D (most dairy products, fatty fish such as salmon, tuna, and mackerel) & E (nuts and seeds, spinach, sweet potatoes) improved cognitive function following repetitive concussive brain injury.

Magnesium and zinc are both depleted following TBI.  Zinc supplementation for four weeks reduced inflammation and neuronal cell death and decreased the symptoms of depression and anxiety in rats following TBI.  Both zing and magnesium can be obtained by eating nuts, seeds, tofu, wheat germ and chocolate. The omega-3 fatty acids DHA and α-linolenic acid were also shown to be neuroprotective in animal studies whether taken prior to, or after, the injury.  Thus, people who participate in contact sports might want to add these fats to their regular diet.  However, don’t waste your money on α-linolenic acid or DHA supplements; adequate amounts are easily obtained via a diet containing fatty fish, flaxseeds, canola oil, soybeans, pumpkin seeds, tofu and walnuts.

Sulforaphane was shown to improve blood–brain barrier integrity, reduce cerebral edema and improve cognition in a rodent model of TBI.  Sulforaphane can be obtained via a diet containing brussels sprouts, broccoli, cabbage, cauliflower, kale, broccoli sprouts, turnips and radish. Finally, enzogenol improved cognition when administered to TBI patients in a randomized, controlled study. Enzogenol is a water extract of the bark from Pinus radiate that contains high levels of proanthocyanidins. Once again, do not waste your money, proanthocyanidins are easily obtained by consuming grapes (seeds and skins), apples, unsweetened baking chocolate, red wines, blueberries, cranberries, bilberries, black currants, hazelnuts, pecans and pistachios.

Interventional studies with natural anti-oxidants and anti-inflammatories via the diet are becoming attractive options for patients with TBI.  Unfortunately, very few clinical trials to treat this neurological condition have been performed. Finally, because I have written so often about this topic in other blogs, I must also recommend a daily puff of marijuana which will reduce the consequences of oxidative stress and brain inflammation following TBI.

© Gary L. Wenk, Ph.D. is the author of The Brain: What Everyone Needs to Know (2017) and Your Brain on Food, 2nd Edition, 2015 (Oxford University Press).

 

via Nutritional Therapies for Traumatic Brain Injury | Psychology Today

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[WEB SITE] Family Caregiver Guide: Introduction to Traumatic Brain Injury (Module 1) – BrainLine

The Defense Health Board, The Defense and Veterans Brain Injury Center and The Department of Veterans Affairs
Family Caregiver Guide: Introduction to Traumatic Brain Injury (Module 1)

Module 1 Summary

In this section, you can find basic information about:

  •  the parts of the brain and what they do
  •  the causes of traumatic brain injury (TBI)
  •  how the brain changes after TBI
  •  how the brain begins to recover.

You can use this information to understand:

  •  how the brain works
  •  what you might see during recovery
  •  why you might see changes in how your service member/veteran
  •  thinks and acts due to a TBI.

TBIs are classified by how severe or serious they are at the time of injury. TBIs range from mild (concussion) to moderate to severe.

This module provides information on moderate to severe TBI. Doctors, nurses, and other health care providers who work with TBI guided
content.

As you read through this document, ask your health care providers to explain what you don’t understand.

Some key points are:

  •  The brain is the body’s control center.
  •  The parts of the brain work together to help us think, feel, move, and talk.
  •  A TBI is caused by a penetrating injury or by blunt force trauma to the head.
  •  TBI is very common in both civilian and military populations.
  •  Many different health care providers will help diagnose and treat your service member/veteran with TBI.
  •  It is the goal of health care providers to minimize complications, the things that can go wrong after the injury.
  •  Many service members/veterans with TBI go through common stages of recovery. Each person, however, progresses at his or her own pace.
  •  Recovery from a TBI may be measured in weeks, months, or years.
  •  Promising new research is showing the brain’s capacity for healing.
  •  There are many ways you can support your service member/veteran with TBI throughout his or her recovery.

Be hopeful. The brain is very good at repairing itself.

Read some of the chapters in this module:

Posted on BrainLine July 5, 2012.

 

via Family Caregiver Guide: Introduction to Traumatic Brain Injury (Module 1) | BrainLine

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[Abstract] No prevention or cure of epilepsy as yet – Invited review

Highlights

  • Approximately 20% of all epilepsy is caused by acute acquired injury such as traumatic brain injury, stroke and CNS infection, with potential to prevent epilepsy
  • No treatment to prevent acquired epilepsy exists; and very few clinical studies have been done during the last 15 years to develop such treatment
  • We review possible reasons for this, possible ways to rectify the situations and note some of the ways currently under way to do so
  • We further review “cures” of epilepsy that occur spontaneously, and after surgical and sometimes medical antiseizure treatments. We note the limited understanding of the mechanisms of such remissions and thus, at present inability to replicate them with targeted therapy

Abstract

Approximately 20% of all epilepsy is caused by acute acquired injury such as traumatic brain injury, stroke and CNS infection. The known onset of the injury which triggers the epileptogenic process, early presentation to medical care, and a latency between the injury and the development of clinical epilepsy present an opportunity to intervene with treatment to prevent epilepsy. No such treatment exists and yet there has been remarkably little clinical research during the last 20 years to try to develop such treatment. We review possible reasons for this, possible ways to rectify the situations and note some of the ways currently under way to do so.

Resective surgical treatment can achieve “cure” in some patients but is sparsely utilized. In certain “self-limiting” syndromes of childhood and adolescence epilepsy remits spontaneously. In a proportion of patients who become seizure free on medications or with dietary treatment, seizure freedom persists when treatment is discontinued. We discuss these situations which can be considered “cures”; and note that at present we have little understanding of mechanism of such cures, and cannot therefore translate them into a treatment paradigm targeting a “cure” of epilepsy.

via No prevention or cure of epilepsy as yet – ScienceDirect

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