Traumatic Brain Injury Poses Long-Term Issues for Insurers
New studies add to the data pool.
The survival rate for TBI patients has dramatically increased in recent years. TBI survivors often request compensation not merely for the acute injuries and chronic impairments they are actually manifesting, but also for their risk of developing additional disorders in the future, a concept commonly referred to as epidemiological risk.
A forthcoming article in the journal Lancet is considered the first “reference study” for determining the epidemiological risk of a TBI claimant developing post-traumatic epilepsy. The population-based study consisted of 1,605,216 people born in Denmark—78,500 experienced at least one head injury, and more than 17,400 had epilepsy. Of the persons with epilepsy, 1,017 had a head injury prior to diagnosis.
These results indicate that a typical person will be more than twice as likely to experience a seizure after a mild TBI and between 7.5 to 9 times as likely to have a seizure after a severe TBI. These are momentous findings, but the situation is actually worse for people older than 15 years of age, with a family history of epilepsy, or females. In older claimants, mild TBI increased the risk by 3.5 times and severe injury by more than 12 times. Patients with a family history of epilepsy are 6 times more likely to have a seizure after a mild injury and 10 times more likely after a severe injury. The risk for women is slightly higher in all groups.
This new reference study is also the first to clearly indicate the long-term epidemiological risk of developing epilepsy after TBI. As shown above in Table 2, the risk remains high for persons with severe injuries or skull fractures even 10 years after the TBI or skull fracture.
Tables 1 and 2 summarize the risk for a group of people. There is no easy way to predict the risk for a single claimant because the risk varies in a complex way that is influenced by age, injury severity, family history, and sex. There are no biomarkers that can predict which claimants will eventually develop epilepsy. There are no methods for continuously monitoring patients for the onset of seizure disorders. Video electroencephalography (EEG) remains the gold standard but is rarely conducted beyond 24-hours because of its high cost. Drug treatment started immediately after TBI is common, but its effectiveness in preventing post-traumatic epilepsy has not been impressive. Nonetheless, it is the only treatment currently available, and this forthcoming study indicates that it may need to be continued much longer than has typically been the case to date.