The objective of this study is to outline the clinical, imaging and electroencephalographic features of post-traumatic epilepsy (PTE).  

PTE occurs in 20-25% of patients with TBI. Identification of clinical, imaging and EEG characteristics associated with PTE may help streamline treatment strategies and improve outcomes. 

• This is a retrospective analysis of 286 PTE patients presenting at two tertiary centers between 2017-2019. The database was stratified for the presence of PTE, MRI and EEG findings, and the use of ASM . The radiographic, as well as electrophysiologic findings were carefully assessed. Successful treatment strategies using a ASM versus an add-on therapy were evaluated.
  

• Post-traumatic Epilepsy was seen in a total of 286 (12.9%) of 2214 patients, of which 60.13% were males and 39.86% were females. The mean age was 47.59 +/- 17.44, while the median age at onset was 32.13 +/- 20.33. Focal seizure semiology was seen in 57.34%, focal to bilateral tonic-clonic in 19.23%, and generalized in 23.42% of patients. About 26.22% presented with an aura. Temporal lobe  involvement was noted in 34.96%, followed by 20.27% with frontal lobe involvement. Around 70.62% of patients had MRI results available, of which 60.89% had abnormal findings: 52% with gliosis, 12.19% with vascular lesions, and 8.13% with cortical dysplasia (dual pathology). About 70% had an abnormal routine EEG; of which 42.28% (85/201) had epileptiform activity, and 82.58% (166/201) had focal or generalized slowing. Levetiracetam was the most commonly used ASD as monotherapy in approximately 20% patients. Refractory epilepsy was noted in 80% of patients despite appropriate treatment.

PTE is more common in men with younger age of onset. In our series, most patients had temporal lobe onset seizures. Levetiracetam is the most commonly used ASM both as monotherapy as well as polytherapy. Overall seizure free rates were low in patients with PTE.