Impact of Post-Traumatic Epilepsy on Mental Health and Multidimensional Outcome and Quality of Life: An NIDILRR TBIMS Study

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dc.contributor.authorAwan, Nabilen
dc.contributor.authorWeppner, Justinen
dc.contributor.authorKumar, Rajen
dc.contributor.authorJuengst, Shannonen
dc.contributor.authorDams-O'Connor, Kristenen
dc.contributor.authorSevigny, Mitchen
dc.contributor.authorZafonte, Rossen
dc.contributor.authorWalker, Williamen
dc.contributor.authorSzaflarski, Jerzyen
dc.contributor.authorWagner, Amyen
dc.date.accessioned2025-01-17T20:14:57Zen
dc.date.available2025-01-17T20:14:57Zen
dc.date.issued2025-01-06en
dc.description.abstractTraumatic brain injury (TBI) and subsequent post-traumatic epilepsy (PTE) often impair daily activities and mental health (MH), which contribute to long-term TBI-related disability. PTE also affects driving capacity, which impacts functional independence, community participation, and satisfaction with life (SWL). However, studies evaluating the collective impact of PTE on multidimensional outcomes are lacking. Thus, we generated a model to investigate how PTE after moderate-to-severe (ms)TBI affects TBI-associated impairments, limits activities and participation, and influences SWL. Of 5108 participants with msTBI enrolled into the National Institute for Disability, Independent Living, and Rehabilitation Research TBI Model Systems between 2010 and 2018 and with seizure-event data available at year-1 post-TBI, 1214 had complete outcome data and 1003 had complete covariate data used for analysis. We constructed a conceptual framework illustrating hypothesized interrelationships between year-1 PTE, driving status, functional independence measure (FIM), depression and anxiety, as well as year-2 participation, and SWL. We performed univariate and multivariable linear and logistic regressions. A covariate-adjusted structural equation model (SEM), using the lavaan package (R), assessed the conceptual framework’s suitability in establishing PTE links with outcomes 1-2 years post-injury. Multiple parameters were evaluated to assess SEM fit. Year-1 PTE was correlated with year-1 FIM motor (standardized coefficient, βstd = −0.112, p = 0.007) and showed a trend level association with year-1 FIM cognition (βstd = −0.070, p = 0.079). Individuals with year-1 PTE were less likely to drive independently at year 1 (βstd = −0.148, p < 0.001). In addition, FIM motor (βstd = 0.323, p < 0.001), FIM cognition (βstd = 0.181, p = 0.012), and anxiety (βstd = −0.135, p = 0.024) influenced driving status. FIM cognition was associated with year-1 depression (βstd = 0.386, p < 0.001) and year-1 anxiety (βstd = 0.396, p < 0.001), whereas year-1 FIM motor (βstd = 0.186, p = 0.003), depression (βstd = −0.322, p = 0.011), and driving status (βstd = 0.233, p < 0.001) directly affected year-2 objective life participation metrics. Moreover, year-1 depression (βstd = −0.382, p = 0.001) and year-2 participation (βstd = 0.160, p < 0.001) had direct effects on year-2 SWL. SWL was influenced indirectly by year-1 variables, including functional impairment, anxiety, and driving status—factors that impacted year-2 participation directly or indirectly, and consequently year-2 SWL, forming a complex relationship with year-1 PTE. A sensitivity analysis SEM showed that the number of MH disorders was associated with participation and SWL (p < 0.001), and this combined MH variable was directly related to driving status (p < 0.02). Developing PTE during year-1 after msTBI affects multiple aspects of life. PTE effects extend to motor and cognitive abilities, driving capabilities, and indirectly, to life participation and overall SWL. The implications underscore the crucial need for effective PTE management strategies during the first year post-TBI to minimize the adverse impact on factors influencing multidimensional year-2 participation and SWL outcomes. Addressing transportation barriers is warranted to enhance the well-being of those with PTE and msTBI, emphasizing a holistic approach. Further research is recommended for SEM validation studies, including testing causal inference pathways that might inform future prevention and treatment trials.en
dc.description.versionAccepted versionen
dc.format.extent18 page(s)en
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.1089/neu.2024.0117en
dc.identifier.eissn1557-9042en
dc.identifier.issn0897-7151en
dc.identifier.orcidWeppner, Justin [0000-0003-1163-5581]en
dc.identifier.pmid39761035en
dc.identifier.urihttps://hdl.handle.net/10919/124252en
dc.language.isoenen
dc.publisherMary Ann Lieberten
dc.relation.urihttps://www.ncbi.nlm.nih.gov/pubmed/39761035en
dc.rightsIn Copyrighten
dc.rights.urihttp://rightsstatements.org/vocab/InC/1.0/en
dc.subjectstructural equations modelen
dc.subjectfunctional impairmenten
dc.subjectinternational classification of functionen
dc.subjectparticipationen
dc.subjectpost-traumatic epilepsyen
dc.subjectpost-traumatic seizureen
dc.subjectquality of lifeen
dc.subjecttraumatic brain injuryen
dc.subjectdrivingen
dc.titleImpact of Post-Traumatic Epilepsy on Mental Health and Multidimensional Outcome and Quality of Life: An NIDILRR TBIMS Studyen
dc.title.serialJournal of Neurotraumaen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.otherArticleen
dcterms.dateAccepted2024-11-25en
pubs.organisational-groupVirginia Techen
pubs.organisational-groupVirginia Tech/Faculty of Health Sciencesen
pubs.organisational-groupVirginia Tech/VT Carilion School of Medicineen
pubs.organisational-groupVirginia Tech/VT Carilion School of Medicine/Internal Medicineen
pubs.organisational-groupVirginia Tech/VT Carilion School of Medicine/Internal Medicine/Physical Medicine & Rehabilitationen
pubs.organisational-groupVirginia Tech/VT Carilion School of Medicine/TEACH Membersen

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