Veterans with post-traumatic brain injury epilepsy more likely to have higher mortality rates

Military veterans who develop epilepsy after a traumatic brain injury may have a higher mortality rate in the following years than veterans who develop epilepsy with no previous traumatic brain injury, according to a study published on October 29, 2025, in Neurology^®, the medical journal of the American Academy of Neurology.

While these findings need to be validated in future studies, we recommend that people who develop epilepsy after a traumatic brain injury are closely monitored, and, especially if seizures do not respond well to treatment, are prioritized for surgery or changing to new medications without delay."

Zulfi Haneef, MD, MBBS, FRCP, study author of Baylor College of Medicine in Houston, Texas, and a Fellow of the American Academy of Neurology

For the study, researchers looked at Veterans Health Administration database information on 210,182 veterans with epilepsy. Of those, 28,832 people had experienced a traumatic brain injury within the five years before their epilepsy diagnosis. This group was an average of 53 years old at the time of diagnosis. The remaining 181,350 people had no traumatic brain injury within five years before their diagnosis. They were an average of 61 years old at diagnosis.

The participants were followed for an average of six years. During that time, 10,780 of the people with epilepsy with traumatic brain injury died, compared to 92,621 of the people with epilepsy without traumatic brain injury.

Once researchers accounted for how long each person spent as part of the study and adjusted for other factors that could affect the mortality rate, they found that overall people with post-traumatic brain injury epilepsy were 2% more likely to die during the study than those with epilepsy without traumatic brain injury.

However, the risk varied based on the cause of the traumatic brain injury. Those with skull or facial fractures had an 18% higher risk of death during the study period; those with diffuse brain injury had a 17% higher risk; and those with localized brain injury had a 16% higher risk.

In contrast, people whose traumatic brain injury was from a concussion had a lower mortality rate than the rate for people with epilepsy with no traumatic brain injury.

Haneef said several possibilities could explain this finding. Some causes of non-traumatic brain injury epilepsy that served as the comparison group, such as stroke, infections, or tumors, have high mortality rates. If compared to the normal population, Haneef said the mortality rates would be much higher.

"It's also possible that when people develop epilepsy after a traumatic brain injury, they receive earlier treatment and may have more access to care and better outcomes than people who have not had a traumatic brain injury," Haneef said.

The researchers also found that people with extracerebral traumatic brain injury who developed epilepsy at a young age-or when they were in the 18-39 age range-were twice as likely to die during the study as young adults with epilepsy but no brain injury.

A limitation of the study was that information about traumatic brain injuries experienced before the people were receiving care from the Veterans Health Administration was limited.

The study was funded by the U.S. Department of Defense.