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Article: Cannabis use disorder contributes to cognitive dysfunction in Veterans with traumatic brain injury.

Esmaeili, Aryan / Dismuke-Greer, Clara / Pogoda, Terri K / Amuan, Megan E / Garcia, Carla / Del Negro, Ariana / Myers, Maddy / Kennedy, Eamonn / Cifu, David / Pugh, Mary Jo

Frontiers in neurology

2024 Volume 15, Page(s) 1261249

Abstract: Background: While emerging evidence supports a link between traumatic brain injury (TBI) and progressive cognitive dysfunction in Veterans, there is insufficient information on the impact of cannabis use disorder (CUD) on long-term cognitive disorders. ... ...

Abstract	Background: While emerging evidence supports a link between traumatic brain injury (TBI) and progressive cognitive dysfunction in Veterans, there is insufficient information on the impact of cannabis use disorder (CUD) on long-term cognitive disorders. This study aimed to examine the incidences of cognitive disorders in Veterans with TBI and CUD and to evaluate their relationship. Methods: This retrospective cohort study used the US Department of Veterans Affairs and Department of Defense administrative data from the Long-term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium Phenotype study. Diagnoses suggesting cognitive disorders after a TBI index date were identified using inpatient and outpatient data from 2003 to 2022. We compared the differential cognitive disorders incidence in Veterans who had the following: (1) no CUD or TBI (control group), (2) CUD only, (3) TBI only, and (4) comorbid CUD+TBI. Kaplan-Meier analyses were used to estimate the overall cognitive disorders incidence in the above study groups. The crude and adjusted Cox proportional hazards models were used to estimate crude and adjusted hazard ratios (HRs) for cognitive disorders. Results: A total of 1,560,556 Veterans [82.32% male, median (IQR) age at the time of TBI, 34.51 (11.29) years, and 61.35% white] were evaluated. The cognitive disorder incidence rates were estimated as 0.68 (95% CI, 0.62, 0.75) for CUD only and 1.03 (95% CI, 1.00, 1.06) for TBI only per 10,000 person-months of observations, with the highest estimated cognitive disorder incidence observed in participants with both TBI and CUD [1.83 (95% CI, 1.72, 1.95)]. Relative to the control group, the highest hazard of cognitive disorders was observed in Veterans with CUD+TBI [hazard ratio (HR), 3.26; 95% CI, 2.91, 3.65], followed by those with TBI only (2.32; 95 CI%, 2.13, 2.53) and with CUD (1.79; 95 CI%, 1.60, 2.00). Of note, in the CUD only subgroup, we also observed the highest risk of an early onset cognitive disorder other than Alzheimer's disease and Frontotemporal dementia. Discussion: The results of this analysis suggest that individuals with comorbid TBI and CUD may be at increased risk for early onset cognitive disorders, including dementia.
Language	English
Publishing date	2024-01-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2024.1261249
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Article: Identifying clinical phenotypes of frontotemporal dementia in post-9/11 era veterans using natural language processing.

Panahi, Samin / Mayo, Jamie / Kennedy, Eamonn / Christensen, Lee / Kamineni, Sreekanth / Sagiraju, Hari Krishna Raju / Cooper, Tyler / Tate, David F / Rupper, Randall / Pugh, Mary Jo

Frontiers in neurology

2024 Volume 15, Page(s) 1270688

Abstract: Introduction: Frontotemporal dementia (FTD) encompasses a clinically and pathologically diverse group of neurodegenerative disorders, yet little work has quantified the unique phenotypic clinical presentations of FTD among post-9/11 era veterans. To ... ...

Abstract	Introduction: Frontotemporal dementia (FTD) encompasses a clinically and pathologically diverse group of neurodegenerative disorders, yet little work has quantified the unique phenotypic clinical presentations of FTD among post-9/11 era veterans. To identify phenotypes of FTD using natural language processing (NLP) aided medical chart reviews of post-9/11 era U.S. military Veterans diagnosed with FTD in Veterans Health Administration care. Methods: A medical record chart review of clinician/provider notes was conducted using a Natural Language Processing (NLP) tool, which extracted features related to cognitive dysfunction. NLP features were further organized into seven Research Domain Criteria Initiative (RDoC) domains, which were clustered to identify distinct phenotypes. Results: Veterans with FTD were more likely to have notes that reflected the RDoC domains, with cognitive and positive valence domains showing the greatest difference across groups. Clustering of domains identified three symptom phenotypes agnostic to time of an individual having FTD, categorized as Low (16.4%), Moderate (69.2%), and High (14.5%) distress. Comparison across distress groups showed significant differences in physical and psychological characteristics, particularly prior history of head injury, insomnia, cardiac issues, anxiety, and alcohol misuse. The clustering result within the FTD group demonstrated a phenotype variant that exhibited a combination of language and behavioral symptoms. This phenotype presented with manifestations indicative of both language-related impairments and behavioral changes, showcasing the coexistence of features from both domains within the same individual. Discussion: This study suggests FTD also presents across a continuum of severity and symptom distress, both within and across variants. The intensity of distress evident in clinical notes tends to cluster with more co-occurring conditions. This examination of phenotypic heterogeneity in clinical notes indicates that sensitivity to FTD diagnosis may be correlated to overall symptom distress, and future work incorporating NLP and phenotyping may help promote strategies for early detection of FTD.
Language	English
Publishing date	2024-02-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2024.1270688
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Article: Comorbidity and polypharmacy impact neurobehavioral symptoms and symptom validity failure among post-9/11 veterans with mild traumatic brain injury.

Swan, Alicia A / Kennedy, Eamonn / Cooper, Douglas B / Amuan, Megan E / Mayo, Jamie / Tate, David F / Song, Kangwon / Eapen, Blessen C / Van Cott, Anne C / Lopez, Maria R / Pugh, Mary Jo

Frontiers in neurology

2023 Volume 14, Page(s) 1228377

Abstract: Objective: The study aimed to examine the association between post-concussive comorbidity burdens [post-traumatic stress disorder (PTSD), depression, and/or headache] and central nervous system (CNS) polypharmacy (five or more concurrent medications) ... ...

Abstract	Objective: The study aimed to examine the association between post-concussive comorbidity burdens [post-traumatic stress disorder (PTSD), depression, and/or headache] and central nervous system (CNS) polypharmacy (five or more concurrent medications) with reported neurobehavioral symptoms and symptom validity screening among post-9/11 veterans with a history of mild traumatic brain injury (mTBI). Setting: Administrative medical record data from the Department of Veterans Affairs (VA) were used in the study. Participants: Post-9/11 veterans with mTBI and at least 2 years of VA care between 2001 and 2019 who had completed the comprehensive traumatic brain injury evaluation (CTBIE) were included in the study. Design: Retrospective cross-sectional design was used in the study. Main measures: Neurobehavioral Symptom Inventory (NSI), International Classification of Diseases, Ninth Revision, and Clinical Modification diagnosis codes were included in the study. Results: Of the 92,495 veterans with a history of TBI, 90% had diagnoses of at least one identified comorbidity (PTSD, depression, and/or headache) and 28% had evidence of CNS polypharmacy. Neurobehavioral symptom reporting and symptom validity failure was associated with comorbidity burden and polypharmacy after adjusting for sociodemographic characteristics. Veterans with concurrent diagnoses of PTSD, depression, and headache were more than six times more likely [Adjusted odds ratio = 6.55 (99% CI: 5.41, 7.92)]. to fail the embedded symptom validity measure (Validity-10) in the NSI. Conclusion: TBI-related multimorbidity and CNS polypharmacy had the strongest association with neurobehavioral symptom distress, even after accounting for injury and sociodemographic characteristics. Given the regular use of the NSI in clinical and research settings, these findings emphasize the need for comprehensive neuropsychological evaluation for individuals who screen positively for potential symptom overreporting, the importance of multidisciplinary rehabilitation to restore functioning following mTBI, and the conscientious utilization of symptom validity measures in research efforts.
Language	English
Publishing date	2023-07-19
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2023.1228377
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Article ; Online: Veteran perspectives of epilepsy care: Impact of Veteran satisfaction, knowledge, and proactivity.

Panahi, Samin / Kennedy, Eamonn / Roghani, Ali / VegaYon, George / VanCott, Anne / Gugger, James J / Raquel Lopez, Maria / Jo Pugh, Mary

Epilepsy & behavior : E&B

2023 Volume 144, Page(s) 109218

Abstract: Objective: Veterans are at elevated risk of epilepsy due to higher rates of traumatic brain injury (TBI). However, little work has examined the extent to which quality of care is associated with key outcomes for Veterans with epilepsy (VWE). This study ... ...

Abstract	Objective: Veterans are at elevated risk of epilepsy due to higher rates of traumatic brain injury (TBI). However, little work has examined the extent to which quality of care is associated with key outcomes for Veterans with epilepsy (VWE). This study aimed to examine the impact of quality of care on three outcomes: patients' knowledge of epilepsy self-care, proactive epilepsy self-management, and satisfaction with care. Method: We conducted a cross-sectional study of Post-9/11 Veterans with validated active epilepsy who received VA care (n = 441). Veterans were surveyed on care processes using American Academy of Neurology epilepsy quality measures, and a patient-generated measure related to the use of emergency care. Outcome measures included epilepsy self-care knowledge, proactive epilepsy self-management, and satisfaction with epilepsy care. Covariates included sociodemographic and health status variables and a measure of patient-provider communication. An ordinary least-squares (OLS) regression model was used to determine if the quality of care was associated with the outcomes adjusting for multiple comparisons. Results: Self-reported measures of quality of care were broadly associated with satisfaction with care and epilepsy knowledge. OLS modeling indicated that healthcare provider guidance on when to seek emergency care was significantly associated with higher Veteran satisfaction with care (p < 0.01). Veterans who were asked about seizure frequency at every visit by their provider also reported higher satisfaction with care (p < 0.01) and increased epilepsy knowledge (p < 0.01). Veteran-provider communication was positively associated with epilepsy knowledge and proactive epilepsy self-management. Veterans with epilepsy with drug resistance epilepsy were significantly less satisfied with their care and reported lower proactivity compared to epilepsy controlled with medications. Further analysis indicated Black VWEs reported lower scores on epilepsy self-care knowledge compared to Whites (p < 0.001). Conclusions: This study found that quality measures were associated with satisfaction and epilepsy knowledge but not associated with proactive self-management in multivariable models. The finding that better communication between providers and Veterans suggests that in addition to technical quality, interpersonal quality is important for patient outcomes. The secondary analysis identified racial disparities in epilepsy knowledge. This work offers opportunities to improve the quality of epilepsy care through the practice of patient-centered care models that reflect Veteran priorities and perceptions.
MeSH term(s)	Humans ; United States ; Veterans ; Cross-Sectional Studies ; Epilepsy/therapy ; Personal Satisfaction ; United States Department of Veterans Affairs ; Patient Satisfaction ; White
Language	English
Publishing date	2023-05-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010587-3
ISSN	1525-5069 ; 1525-5050
ISSN (online)	1525-5069
ISSN	1525-5050
DOI	10.1016/j.yebeh.2023.109218
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Article ; Online: Discriminating Residue Substitutions in a Single Protein Molecule Using a Sub-nanopore.

Dong, Zhuxin / Kennedy, Eamonn / Hokmabadi, Mohammad / Timp, Gregory

ACS nano

2017 Volume 11, Issue 6, Page(s) 5440–5452

Abstract: It is now possible to create, in a thin inorganic membrane, a single, sub-nanometer-diameter pore (i.e., a sub-nanopore) about the size of an amino acid residue. To explore the prospects for sequencing protein with it, measurements of the force and ... ...

Abstract	It is now possible to create, in a thin inorganic membrane, a single, sub-nanometer-diameter pore (i.e., a sub-nanopore) about the size of an amino acid residue. To explore the prospects for sequencing protein with it, measurements of the force and current were performed as two denatured histones, which differed by four amino acid residue substitutions, were impelled systematically through the sub-nanopore one at a time using an atomic force microscope. The force measurements revealed that once the denatured protein, stabilized by sodium dodecyl sulfate (SDS), translocated through the sub-nanopore, a disproportionately large force was required to pull it back. This was interpreted to mean that the SDS was cleaved from the protein during the translocation. The force measurements also exposed a dichotomy in the translocation kinetics: either the molecule slid nearly frictionlessly through the pore or it slipped-and-stuck. When it slid frictionlessly, regardless of whether the molecule was pulled N-terminus or C-terminus first through the pore, regular patterns were observed intermittently in the force and blockade current fluctuations that corresponded to the distance between stretched residues. Furthermore, the amplitude of the fluctuations in the current blockade were correlated with the occluded volume associated with the amino acid residues in the pore. Finally, a comparison of the patterns in the current fluctuations associated with the two practically identical histones supported the conclusion that a sub-nanopore was sensitive enough to discriminate amino acid substitutions in the sequence of a single protein molecule by measuring volumes of 0.1 nm
MeSH term(s)	Amino Acid Substitution ; Animals ; Biotinylation ; Cattle ; Histones/chemistry ; Histones/genetics ; Kinetics ; Microscopy, Atomic Force/methods ; Models, Molecular ; Motion ; Nanopores/ultrastructure ; Protein Denaturation ; Sequence Analysis, Protein/methods ; Serum Albumin, Bovine/chemistry ; Sodium Dodecyl Sulfate/chemistry ; Streptavidin/chemistry
Chemical Substances	Histones ; Serum Albumin, Bovine (27432CM55Q) ; Sodium Dodecyl Sulfate (368GB5141J) ; Streptavidin (9013-20-1)
Language	English
Publishing date	2017-06-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ISSN	1936-086X
ISSN (online)	1936-086X
DOI	10.1021/acsnano.6b08452
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Article ; Online: Secret messaging with endogenous chemistry.

Kennedy, Eamonn / Geiser, Joseph / Arcadia, Christopher E / Weber, Peter M / Rose, Christopher / Rubenstein, Brenda M / Rosenstein, Jacob K

Scientific reports

2021 Volume 11, Issue 1, Page(s) 13960

Abstract: Data encoded in molecules offers opportunities for secret messaging and extreme information density. Here, we explore how the same chemical and physical dimensions used to encode molecular information can expose molecular messages to detection and ... ...

Abstract	Data encoded in molecules offers opportunities for secret messaging and extreme information density. Here, we explore how the same chemical and physical dimensions used to encode molecular information can expose molecular messages to detection and manipulation. To address these vulnerabilities, we write data using an object's pre-existing surface chemistry in ways that are indistinguishable from the original substrate. While it is simple to embed chemical information onto common objects (covers) using routine steganographic permutation, chemically embedded covers are found to be resistant to detection by sophisticated analytical tools. Using Turbo codes for efficient digital error correction, we demonstrate recovery of secret keys hidden in the pre-existing chemistry of American one dollar bills. These demonstrations highlight ways to improve security in other molecular domains, and show how the chemical fingerprints of common objects can be harnessed for data storage and communication.
Language	English
Publishing date	2021-07-06
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-92987-2
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Article ; Online: Reading the primary structure of a protein with 0.07 nm

Kennedy, Eamonn / Dong, Zhuxin / Tennant, Clare / Timp, Gregory

Nature nanotechnology

2016 Volume 11, Issue 11, Page(s) 968–976

Abstract: The primary structure of a protein consists of a sequence of amino acids and is a key factor in determining how a protein folds and functions. However, conventional methods for sequencing proteins, such as mass spectrometry and Edman degradation, suffer ... ...

Abstract	The primary structure of a protein consists of a sequence of amino acids and is a key factor in determining how a protein folds and functions. However, conventional methods for sequencing proteins, such as mass spectrometry and Edman degradation, suffer from short reads and lack sensitivity, so alternative approaches are sought. Here, we show that a subnanometre-diameter pore, sputtered through a thin silicon nitride membrane, can be used to detect the primary structure of a denatured protein molecule. When a denatured protein immersed in electrolyte is driven through the pore by an electric field, measurements of a blockade in the current reveal nearly regular fluctuations, the number of which coincides with the number of residues in the protein. Furthermore, the amplitudes of the fluctuations are highly correlated with the volumes that are occluded by quadromers (four residues) in the primary structure. Each fluctuation, therefore, represents a read of a quadromer. Scrutiny of the fluctuations reveals that the subnanometre pore is sensitive enough to read the occluded volume that is related to post-translational modifications of a single residue, measuring volume differences of ∼0.07 nm
MeSH term(s)	Amino Acid Sequence ; Image Processing, Computer-Assisted ; Lab-On-A-Chip Devices ; Lysine/chemistry ; Membranes, Artificial ; Mercaptoethanol/chemistry ; Microscopy, Electron, Scanning Transmission/instrumentation ; Nanotechnology/instrumentation ; Nanotechnology/methods ; Protein Denaturation ; Proteins/analysis ; Proteins/chemistry ; Silicon Compounds ; Sodium Dodecyl Sulfate/chemistry
Chemical Substances	Membranes, Artificial ; Proteins ; Silicon Compounds ; Sodium Dodecyl Sulfate (368GB5141J) ; Mercaptoethanol (60-24-2) ; Lysine (K3Z4F929H6) ; silicon nitride (QHB8T06IDK)
Language	English
Publishing date	2016-07-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2254964-X
ISSN	1748-3395 ; 1748-3387
ISSN (online)	1748-3395
ISSN	1748-3387
DOI	10.1038/nnano.2016.120
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Article ; Online: Persistent MRI Findings Unique to Blast and Repetitive Mild TBI: Analysis of the CENC/LIMBIC Cohort Injury Characteristics.

Military medicine

2024

Abstract: Introduction: MRI represents one of the clinical tools at the forefront of research efforts aimed at identifying diagnostic and prognostic biomarkers following traumatic brain injury (TBI). Both volumetric and diffusion MRI findings in mild TBI (mTBI) ... ...

Abstract	Introduction: MRI represents one of the clinical tools at the forefront of research efforts aimed at identifying diagnostic and prognostic biomarkers following traumatic brain injury (TBI). Both volumetric and diffusion MRI findings in mild TBI (mTBI) are mixed, making the findings difficult to interpret. As such, additional research is needed to continue to elucidate the relationship between the clinical features of mTBI and quantitative MRI measurements. Material and methods: Volumetric and diffusion imaging data in a sample of 976 veterans and service members from the Chronic Effects of Neurotrauma Consortium and now the Long-Term Impact of Military-Relevant Brain Injury Consortium observational study of the late effects of mTBI in combat with and without a history of mTBI were examined. A series of regression models with link functions appropriate for the model outcome were used to evaluate the relationships among imaging measures and clinical features of mTBI. Each model included acquisition site, participant sex, and age as covariates. Separate regression models were fit for each region of interest where said region was a predictor. Results: After controlling for multiple comparisons, no significant main effect was noted for comparisons between veterans and service members with and without a history of mTBI. However, blast-related mTBI were associated with volumetric reductions of several subregions of the corpus callosum compared to non-blast-related mTBI. Several volumetric (i.e., hippocampal subfields, etc.) and diffusion (i.e., corona radiata, superior longitudinal fasciculus, etc.) MRI findings were noted to be associated with an increased number of repetitive mTBIs versus. Conclusions: In deployment-related mTBI, significant findings in this cohort were only observed when considering mTBI sub-groups (blast mechanism and total number/dose). Simply comparing healthy controls and those with a positive mTBI history is likely an oversimplification that may lead to non-significant findings, even in consortium analyses.
Language	English
Publishing date	2024-02-24
Publishing country	England
Document type	Journal Article
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usae031
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Article ; Online: Phenotyping Depression After Mild Traumatic Brain Injury: Evaluating the Impact of Multiple Injury, Gender, and Injury Context.

Kennedy, Eamonn / Ozmen, Mustafa / Bouldin, Erin D / Panahi, Samin / Mobasher, Helal / Troyanskaya, Maya / Martindale, Sarah L / Merritt, Victoria C / O'Neil, Maya / Sponheim, Scott R / Remigio-Baker, Rosemay A / Presson, Angela / Swan, Alicia A / Werner, J Kent / Greene, Tom H / Wilde, Elisabeth A / Tate, David F / Walker, William C / Pugh, Mary Jo

Journal of neurotrauma

2024 Volume 41, Issue 7-8, Page(s) 924–933

Abstract: The chronic mental health consequences of mild traumatic brain injury (TBI) are a leading cause of disability. This is surprising given the expectation of significant recovery after mild TBI, which suggests that other injury-related factors may ... ...

Abstract	The chronic mental health consequences of mild traumatic brain injury (TBI) are a leading cause of disability. This is surprising given the expectation of significant recovery after mild TBI, which suggests that other injury-related factors may contribute to long-term adverse outcomes. The objective of this study was to determine how number of prior injuries, gender, and environment/context of injury may contribute to depressive symptoms after mild TBI among deployed United States service members and veterans (SMVs). Data from the Long-term Impact of Military-Relevant Brain Injury Consortium Prospective Longitudinal Study was used to assess TBI injury characteristics and depression scores previously measured on the Patient Health Questionnaire-9 (PHQ-9) among a sample of 1456 deployed SMVs. Clinical diagnosis of mild TBI was defined via a multi-step process centered on a structured face-to-face interview. Logistical and linear regressions stratified by gender and environment of injury were used to model depressive symptoms controlling for sociodemographic and combat deployment covariates. Relative to controls with no history of mild TBI (
MeSH term(s)	Male ; Humans ; Female ; United States/epidemiology ; Brain Concussion/complications ; Depression/epidemiology ; Depression/etiology ; Depression/psychology ; Longitudinal Studies ; Prospective Studies ; Military Personnel/psychology ; Brain Injuries, Traumatic/complications ; Veterans/psychology ; Stress Disorders, Post-Traumatic/etiology ; Multiple Trauma
Language	English
Publishing date	2024-01-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2023.0381
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Article ; Online: Role of Deployment History on the Association Between Epilepsy and Traumatic Brain Injury in Post-9/11 Era US Veterans.

Henion, Amy K / Wang, Chen-Pin / Amuan, Megan / Altalib, Hamada H / Towne, Alan R / Hinds, Sidney R / Baca, Christine / LaFrance, W Curt / Van Cott, Anne C / Kean, Jacob / Roghani, Ali / Kennedy, Eamonn / Panahi, Samin / Pugh, Mary Jo V

Neurology

2023 Volume 101, Issue 24, Page(s) e2571–e2584

Abstract: Background and objectives: Traumatic brain injury (TBI) is a well-established epilepsy risk factor and is common among service members. Deployment-related TBI, where combat/blast may be more common, may have different outcomes than nondeployment-related ...

Abstract	Background and objectives: Traumatic brain injury (TBI) is a well-established epilepsy risk factor and is common among service members. Deployment-related TBI, where combat/blast may be more common, may have different outcomes than nondeployment-related TBI. This work examined associations of all TBI exposures (not just combat), and epilepsy, while adjusting for comorbidities associated with epilepsy, among veterans by deployment status. Methods: The cohort included post-9/11 veterans with ≥2 years of care in both Veterans Health Administration and Defense Health Agency systems. We identified epilepsy using Results: The cohort (n = 938,890) included post-9/11 veterans of whom 27,436 (2.92%) had epilepsy. Most veterans had a history of deployment (70.64%), referred to as "deployed." Epilepsy was more common among veterans who were never deployed ("nondeployed") (3.85% vs 2.54%). Deployed veterans were more likely to have had TBI, compared with the nondeployed veterans (33.94% vs 14.24%), but nondeployed veterans with moderate/severe TBI had higher odds of epilepsy compared with deployed veterans (adjusted odds ratio [aOR] 2.92, 95% CI 2.68-3.17 vs aOR 2.01, 95% CI 1.91-2.11). Penetrating TBI had higher odds of epilepsy among the deployed veterans (aOR 5.33, 95% CI 4.89-5.81), whereas the odds of epilepsy for mild TBI did not significantly differ by deployment status. Although most neurologic conditions were more prevalent among the nondeployed veterans, they were often associated with higher odds of epilepsy in the deployed veterans. Discussion: Deployment history had a significant differential impact on epilepsy predictors. As expected, penetrating TBI had a greater epilepsy impact among deployed veterans perhaps due to combat/blast. Some epilepsy predictors (moderate/severe TBI, multiple sclerosis, and Parkinson disease) had a stronger association in the nondeployed veterans suggesting a potential healthy warrior effect in which such conditions preclude deployment. Other neurologic conditions (e.g., brain tumor, Alzheimer disease/frontotemporal dementia) had a greater epilepsy impact in the deployed veterans. This may be attributable to deployment-related exposures (combat injury, occupational exposures). A better understanding of deployment effects is critical to provide targeted epilepsy prevention in veterans and military service members.
MeSH term(s)	Humans ; Veterans ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/epidemiology ; Military Personnel ; Comorbidity ; Epilepsy/epidemiology
Language	English
Publishing date	2023-11-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000207943
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