@article{ref1,
title="The role of deployment history on the association between epilepsy and traumatic brain injury in post-9/11 era U.S. veterans",
journal="Neurology",
year="2023",
author="Henion, Amy K. and Wang, Chen-Pin and Amuan, Megan and Altalib, Hamada H. and Towne, Alan R. and Hinds, Sidney R. and Baca, Christine and LaFrance, W. Curt Jr and Van Cott, Anne C. and Kean, Jacob and Roghani, Ali and Kennedy, Eamonn and Panahi, Samin and Jo V Pugh, Mary",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is a well-established epilepsy risk factor and is common among service members. Deployment related TBI, where combat/blast may be more common, may have different outcomes than non-deployment related TBI. This work examined associations of all TBI exposures (not just combat), and epilepsy, while adjusting for comorbidities associated with epilepsy, among Veterans by deployment status. <br><br>METHODS: The cohort included post-9/11 Veterans with ≥ 2 years of care in both Veterans Health Administration (VHA) and Defense Health Agency (DHA) systems. We identified epilepsy using ICD-9/10-CM codes, anti-seizure medication, and service-connected disability for epilepsy. We conducted a logistic regression model with interaction terms for conditions by deployment history that adjusted for demographics and military characteristics. <br><br>RESULTS: The cohort (n=938,890) included post-9/11 Veterans of which 27,436 (2.92%) had epilepsy. Most Veterans had a history of deployment (70.64%), referred to as &quot;deployed&quot;. Epilepsy was more common among Veterans who were never deployed (&quot;non-deployed&quot;) (3.85% vs. 2.54%). Deployed Veterans were more likely to have had TBI, compared to the non-deployed (33.94% vs. 4.24%), but non-deployed Veterans with moderate/severe TBI had higher odds of epilepsy compared to deployed Veterans (aOR=2.92, 95% CI: 2.68-3.17 vs. aOR=2.01, 95% CI: 1.91-2.11). Penetrating TBI had higher odds of epilepsy among the deployed (aOR=5.33, 95% CI: 4.89-5.81), whereas the odds of epilepsy for mild TBI did not significantly differ by deployment status. Though most neurological conditions were more prevalent among non-deployed, they were often associated with higher odds of epilepsy in the deployed. <br><br>DISCUSSION: Deployment history had a significant differential impact on epilepsy predictors. As expected, penetrating TBI had a greater epilepsy impact among deployed Veterans perhaps due to combat/blast. Some epilepsy predictors (moderate/severe TBI, MS, Parkinson's disease) had a stronger association in the non-deployed suggesting a potential healthy warrior effect in which such conditions preclude deployment. Other neurological conditions (e.g., brain tumor, Alzheimer's disease/frontotemporal dementia) had a greater epilepsy impact in the deployed. This may be attributable to deployment related exposures (combat injury, occupational exposures). A better understanding of deployment effects is critical to provide targeted epilepsy prevention in Veterans and military service members.<p /> <p>Language: en</p>",
language="en",
issn="0028-3878",
doi="10.1212/WNL.0000000000207943",
url="http://dx.doi.org/10.1212/WNL.0000000000207943"
}