POST-TRAUMATIC EPILEPSY AFTER TRAUMATIC BRAIN INJURY: PATHOPHYSIOLOGICAL BASIS, THERAPEUTIC CHALLENGES, AND THE ROLE OF TOPIRAMATE

Abstract

Post-traumatic epilepsy (PTE) is one of the most severe and socially significant complications of traumatic brain injury (TBI), leading to long-term neurological disability, impaired quality of life, and limited social reintegration. The development of PTE is driven by a complex cascade of pathophysiological mechanisms, including primary mechanical brain injury, secondary ischemic and metabolic disturbances, excitotoxicity, neuroinflammation, and long-term maladaptive neuroplasticity. Although conventional antiepileptic drugs are widely used for seizure control after TBI, their administration is frequently associated with worsening cognitive and affective deficits, which are closely linked to the phenomenon of post-traumatic neural depression. This article reviews current concepts of PTE pathogenesis, major risk factors, and unresolved therapeutic challenges. Particular emphasis is placed on topiramate, a broad-spectrum antiepileptic drug with multimodal mechanisms of action and potential neuroprotective properties. Clinical observations indicate that topiramate provides seizure control comparable to traditional antiepileptic therapy while demonstrating superior outcomes in cognitive performance and depressive symptom reduction. These findings support the use of topiramate as a promising therapeutic option in the long-term management of post-traumatic epilepsy.