How does a diffuse brain injury lead to post-traumatic epilepsy?

Work from Ramon Diaz-Arrastia, MD, PhD, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, and his team demonstrated that a substantial fraction of individuals who develop epilepsy following a traumatic brain injury (TBI) have a non-lesional MRI, indicative of damage due to diffuse mechanisms rather than a focal injury. The proposed pathogenic mechanisms in these cases differ substantially from the traditional model of post-traumatic epilepsy, in which contusions lead to scarring and altered circuitry. One hypothesis suggests that axonal injury occurs in tracts into and out of particular brain structures due to the shearing and stretching forces that occur in TBI. This may lead to wallerian degeneration and atrophy or rewiring following deafferentation. This interview took place at the American Epilepsy Society (AES) Annual Meeting 2022 in Nashville, TN.
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