Post-Traumatic Seizures: What to Watch For and What to Do
Around 5–15% of people with a traumatic brain injury (TBI) will have a seizure at some point. Seizures can happen right after the injury or months to years later. Knowing the signs, the differences between early and late seizures, and the basic treatments can make a real difference for recovery.
Causes & risk factors
Post-traumatic seizures happen because injured brain tissue becomes more likely to fire off abnormal electrical signals. The bigger the injury, the higher the risk. Key risk factors include severe TBI, skull fractures, bleeding inside the skull (like subdural or intracerebral hemorrhage), penetrating head wounds, and a history of seizures. Older adults and people with alcohol withdrawal after head trauma also face higher odds.
We group seizures after trauma into two types: early and late. Early seizures occur within the first seven days after the injury and are often linked to the immediate damage, swelling, or bleeding. Late seizures start after the first week and often reflect permanent changes in the brain’s wiring—this can lead to epilepsy if seizures repeat.
What to do and common treatments
If you see someone seizing after a head injury, protect their airway, roll them gently onto their side, remove nearby hazards, and time the seizure. Call emergency services for seizures that last longer than five minutes, repeat without recovery, or happen with breathing trouble. In the ER, doctors focus on airway, oxygen, and stopping the seizure—usually with a benzodiazepine like lorazepam for immediate control.
Preventing early seizures is a standard step after severe TBI. Doctors often give short-term antiseizure medication for the first seven days to lower the chance of early seizures. Phenytoin (Dilantin) has been used a long time for this purpose, but levetiracetam is now common because it has fewer interactions and side effects. For late or repeated seizures, longer-term treatment and neurology follow-up are needed.
Diagnosis may include CT or MRI to check for new bleeding or swelling, and an EEG to see ongoing abnormal electrical activity. EEGs are useful if seizures are subtle—like staring spells or confused episodes—because not all seizures have big convulsions.
Practical tips: take prescribed medication exactly as directed, avoid alcohol and illegal drugs, get good sleep, and wear a helmet for activities with head-injury risk. Ask your doctor about driving rules—many places require a seizure-free period before you can drive again. Follow-up with neurology is important if you have any seizure after head trauma, even if it was a single event.
If you want more detail on specific medications like phenytoin or on seizure first aid, check trusted medical sources or talk to your healthcare team. Quick action and proper follow-up cut risks and help people get back to daily life safely.
May, 16 2023