Can TBI biomarkers forecast seizures after injury?

Thursday, April 4, 2019
By Alissa Kocer

Medicine and Neurology partnership receive Department of Defense Grant to investigate traumatic brain injuries and secondary illnesses

Millions of Americans suffer traumatic brain injuries (TBI) every year. Common causes of TBIs include car accidents, falls, sports injuries, incidents involving firearms, domestic abuse, blast injuries while serving in the armed forces, and similar events. While many people with TBIs fully recover from their injuries, not all do; some go on to develop a host of secondary injuries, including epilepsy. About 30 percent of patients with severe TBIs end up having seizures within one year. Currently, there is no way to tell who is at an increased risk for developing epilepsy after a TBI.

Tim Veldman, Ph.D., senior research scientist in the Center for Applied Genomics and Precision Medicine (CAGPM), wants to change that. He is collaborating with Saurabh Sinha, M.D., Ph.D., associate professor of neurology, on a two-year grant through the Department of Defense to follow patients who have suffered severe TBIs. 

“Making an initial diagnosis of epilepsy can be challenging, often relying on patients to recall their experiences or on eye-witness reports,” Veldman said. “We are working to develop a blood test that can tell if a person had a seizure, but, even better, what if a blood test could also tell if you are at a high risk for having another seizure or when that seizure will occur?”  

Standard tests like MRIs and EEGs for first seizures are often negative, so typical clinical practice is to wait until a patient has a second seizure before prescribing anti-seizure medications. This can leave patients with a lot of anxiety and uncertainty as they don’t know when – or if – another seizure will strike.

Alternatively, several patients with TBIs have seizures at the time of the event, so doctors will often prescribe seizure medication, even though the patient may not have had another seizure without medication. This means that patients may potentially be placed on medications for much longer than needed, incurring adverse drug side effects, not to mention additional costs.

Veldman and Sinha will follow the progress of and collect several blood samples from patients with severe TBIs over a two-year period. They hope to discover changes in patients’ blood, specifically their microRNAs, that will serve as biomarkers to detect the potential risk for developing epilepsy following a TBI. They can compare this data to the patients with TBIs who don’t go on to develop epilepsy to see the difference in biomarkers.

“We need to help doctors do a better job of knowing whether to have patients with a TBI continue with seizure medications or not,” Veldman said. 

Eventually this work could be broadened to include patients other than those with TBIs. Currently, 50 million people worldwide live with epilepsy. Ultimately, Veldman wants to help all people affected by seizures take better control of their seizures by giving them tools that will help determine if they are at a high risk for having a seizure hours before onset. That will allow people to plan their days better. If they know they are at a high risk for a seizure that day, they can avoid activities like driving, swimming or going to work, and instead prepare themselves and alert their caretakers, family or friends, so they can have help on hand if needed. 

“The holy grail would be a portable or wearable device that would let a person know they are about to have a seizure,” Veldman said. “But we’ve got to start somewhere.”