Post-traumatic seizures and post-traumatic epilepsy after traumatic brain injury: current approaches to prevention, diagnosis, and risk prediction

Abstract

Objective: To summarize current international and national evidence regarding the mechanisms underlying posttraumatic seizures and posttraumatic epilepsy following traumatic brain injury, to identify the main clinically relevant risk factors, and to outline approaches to seizure prophylaxis, neurophysiological monitoring, and prediction of long-term outcomes.

Materials and methods: Publications from the PubMed, Scopus, and Web of Science databases, published predominantly between 2020 and 2025, as well as relevant national sources, were analyzed. The review included clinical practice guidelines, systematic reviews, meta-analyses, and key original studies addressing posttraumatic seizures and epileptogenesis after traumatic brain injury.

Results: Early posttraumatic seizures were found to be primarily associated with acute metabolic and structural brain disturbances, whereas late seizures are usually considered a clinical manifestation of established posttraumatic epilepsy resulting from prolonged processes of epileptogenesis, neuroinflammation, microglial activation, and synaptic network remodeling. Prophylactic use of antiseizure medications is associated with a reduction in the incidence of early posttraumatic seizures but does not prevent the development of posttraumatic epilepsy. Electroencephalography and continuous EEG monitoring play an important role in risk stratification and in the detection of subclinical (nonconvulsive) seizures.

Conclusions: Management of patients with traumatic brain injury and posttraumatic seizures requires a differentiated multidisciplinary approach integrating clinical, neurophysiological, and neuroimaging risk factors. Further research should focus on improving prediction of posttraumatic epilepsy and identifying validated biomarkers of epileptogenesis.