Veterans who develop epilepsy following a traumatic brain injury (TBI) face a significantly higher risk of death compared to veterans whose epilepsy stems from other causes. A large-scale study published on October 29, 2025, in Neurology, the medical journal of the American Academy of Neurology, has quantified this increased danger, revealing that the type and severity of the initial injury play a crucial role in long-term survival. The findings highlight a critical need for heightened surveillance and tailored treatment for a population that may appear healthy but carries hidden, life-threatening risks.
The research, conducted by a team at Baylor College of Medicine, analyzed the health records of over 210,000 veterans with epilepsy from the Veterans Health Administration database. Of this group, nearly 29,000 had experienced a TBI within the five years preceding their epilepsy diagnosis. Investigators followed the participants for an average of six years, discovering that veterans with post-traumatic epilepsy were 2% more likely to die during the study period than their counterparts with non-traumatic epilepsy. While a 2% increase may seem modest, researchers stress its importance, as it is relative to a baseline group already facing elevated mortality rates.
A Closer Look at the Numbers
The study provided a detailed breakdown of how different types of traumatic brain injuries correlate with mortality risk in veterans who subsequently develop epilepsy. The data show a clear connection between the severity of the initial trauma and the likelihood of premature death. These insights help clinicians identify which patients may require the most intensive monitoring and intervention following an epilepsy diagnosis.
Injury Type and Associated Risk
The analysis revealed that specific kinds of head injuries carry substantially different mortality risks. Veterans whose TBI involved skull or facial fractures had an 18% higher risk of death during the study period compared to veterans with non-traumatic epilepsy. Those with a diffuse brain injury, which affects the brain’s widespread network of nerve fibers, faced a 17% higher risk. A localized brain injury, which damages a specific part of the brain, was associated with a 16% higher mortality risk. According to researchers, severe injuries of this nature likely provoke high levels of inflammation in the brain, which can increase the risk of developing epilepsy.
Vulnerability in Younger Veterans
One of the most concerning findings from the study was the disproportionate impact on younger veterans. Individuals in the 18–39 age range who developed epilepsy after an extracerebral TBI—an injury to tissues outside the brain that still affects brain function—were twice as likely to die during the study as young adults whose epilepsy was not related to trauma. This finding is particularly alarming because these veterans may appear outwardly healthy and recovered from their initial injuries. Rohan Nagabhirava, a student at Baylor’s School of Medicine and the study’s primary author, described this group as “particularly vulnerable,” noting that the long-term consequences of their injuries can be “serious, even fatal.”
The Concussion Anomaly
In a surprising twist, the study found that veterans who developed epilepsy after a concussion had a lower mortality rate than people with epilepsy from non-traumatic causes. Researchers offered several potential explanations for this unexpected result. The comparison group—veterans with non-traumatic epilepsy—often develop the condition due to underlying health issues that carry high mortality rates on their own, such as strokes, brain tumors, or severe infections. Therefore, the lower relative risk for the concussion group does not imply that post-concussion epilepsy is benign, but rather that other forms of epilepsy can be even more dangerous.
Factors Influencing the Anomaly
Senior author Dr. Zulfi Haneef, a professor of neurology at Baylor and director at the Michael E. DeBakey VA Hospital, suggested another possibility for the concussion finding. He explained that individuals who develop epilepsy after a known TBI event like a concussion might receive earlier diagnosis and more focused medical care. This improved access to treatment and better health outcomes could contribute to their comparatively lower mortality rate when measured against those whose epilepsy emerges from less obvious causes.
Clinical Implications and Recommendations
The study’s findings carry significant weight for the clinical care of veterans and others who have sustained a traumatic brain injury. The clear link between TBI-related epilepsy and increased mortality underscores the need for proactive and specialized medical management. Dr. Haneef emphasized that the results call for early detection, aggressive treatment, and continuous monitoring for any veteran with a history of TBI.
The research team strongly recommends that individuals who develop epilepsy after a TBI be monitored closely. They further advise that if a patient’s seizures do not respond well to initial treatments, they should be prioritized for advanced options, such as surgery or new medications, without delay. Dr. Haneef stated that treatment should be “prompt and tailored to each individual’s risk factors.” This personalized approach is critical, especially given the varying risk levels associated with different types of brain injuries. The study serves as a crucial reminder that the consequences of TBI are long-lasting and require a dedicated, vigilant approach to medical care.