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Role of Deployment History on the Association Between Epilepsy and Traumatic Brain Injury in Post-9/11 Era US
Amy K Henion1, Chen-Pin Wang1, Megan Amuan1
1From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City.
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 nondeployment-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.
Methods:
The cohort included post-9/11 veterans with ≥2 years of care in both Veterans Health Administration and Defense Health Agency systems. We identified epilepsy using ICD-9/10-CM codes, antiseizure 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.
Results:
The cohort (n = 938,890) included post-9/11 veterans of whom 27,436 (2.92%) had epilepsy. Most veterans had a history of deployment (70.64%), referred to as "deployed." Epilepsy was more common among veterans who were never deployed ("nondeployed") (3.85% vs 2.54%). Deployed veterans were more likely to have had TBI, compared with the nondeployed veterans (33.94% vs 14.24%), but nondeployed veterans with moderate/severe TBI had higher odds of epilepsy compared with deployed veterans (adjusted odds ratio [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 veterans (aOR 5.33, 95% CI 4.89-5.81), whereas the odds of epilepsy for mild TBI did not significantly differ by deployment status. Although most neurologic conditions were more prevalent among the nondeployed veterans, they were often associated with higher odds of epilepsy in the deployed veterans.
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, multiple sclerosis, and Parkinson disease) had a stronger association in the nondeployed veterans suggesting a potential healthy warrior effect in which such conditions preclude deployment. Other neurologic conditions (e.g., brain tumor, Alzheimer disease/frontotemporal dementia) had a greater epilepsy impact in the deployed veterans. 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.
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