Early post‐traumatic seizures in children: Clinical and radiological aspects of injury

Ong, Lai Choo; Dhillon, M K; Selladurai, Benedict M.; Maimunah, A; Lye, M. S.

doi:10.1111/j.1440-1754.1996.tb00917.x

Cited by 40 publications

(55 citation statements)

References 21 publications

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“…2,6,13,15,17,19 Half of our older cohort with seizures had only clinical seizures, which could presumably be recognized without cEEG, whereas only 5% of the group had any subclinical seizures. The older group also had a lower seizure burden as evidenced by the low rate of status epilepticus and the fact that half of these patients had 1 or 2 seizures.…”

Section: Older Patientsmentioning

confidence: 99%

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Incidence of seizures on continuous EEG monitoring following traumatic brain injury in children

O’Neill¹,

Handler²,

Tong

et al. 2015

PED

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OBJECT Seizures may cause diagnostic confusion and be a source of metabolic stress after traumatic brain injury (TBI) in children. The incidence of electroencephalography (EEG)-confirmed seizures and of subclinical seizures in the pediatric population with TBI is not well known. METHODS A routine protocol for continuous EEG (cEEG) monitoring was initiated for all patients with moderate or severe TBI at a Level 1 pediatric trauma center. Over a 3.5-year period, all patients with TBI who underwent cEEG monitoring, both according to protocol and those with mild head injuries who underwent cEEG monitoring at the discretion of the treating team, were identified prospectively. Clinical data were collected and analyzed. RESULTS Over the study period, 594 children were admitted with TBI, and 144 of these children underwent cEEG monitoring. One hundred two (71%) of these 144 children had moderate or severe TBI. Abusive head trauma (AHT) was the most common mechanism of injury (65 patients, 45%) in children with cEEG monitoring. Seizures were identified on cEEG in 43 patients (30%). Forty (93%) of these 43 patients had subclinical seizures, including 17 (40%) with only subclinical seizures and 23 (53%) with both clinical and subclinical seizures. Fifty-three percent of patients with seizures experienced status epilepticus. Age less than 2.4 years and AHT mechanism were strongly correlated with presence of seizures (odds ratios 8.7 and 6.0, respectively). Those patients with only subclinical seizures had the same risk factors as the other groups. The presence of seizures did not correlate with discharge disposition but was correlated with longer hospital stay and intensive care unit stay. CONCLUSIONS Continuous EEG monitoring identifies a significant number of subclinical seizures acutely after TBI. Children younger than 2.4 years of age and victims of AHT are particularly vulnerable to subclinical seizures, and seizures in general. Continuous EEG monitoring allows for accurate diagnosis and timely treatment of posttraumatic seizures, and may mitigate secondary injury to the traumatized brain.

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Section: Older Patientsmentioning

confidence: 99%

“…2,6,13,15,17,19 Continuous electroencephalography (cEEG) is the only test to definitively diagnose subclinical seizures. It additionally offers a continuous record of any seizure activity that may have otherwise gone unwitnessed.…”

mentioning

confidence: 99%

Incidence of seizures on continuous EEG monitoring following traumatic brain injury in children

O’Neill¹,

Handler²,

Tong

et al. 2015

PED

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“…Interestingly, the development of a subdural hematoma, a pathological finding that has been identified as an independent risk factor for posttraumatic seizures after pediatric [2,3,17] or adult [2,3,17] TBI, is more likely after inflicted than after noninflicted TBI [7,16] .…”

Section: Introductionmentioning

confidence: 99%

“…Posttraumatic seizures are a common complication of pediatric TBI [2][3][4] . Further, posttraumatic epilepsy, defined as recurrent, ilarly, among a cohort of 125 children (mean age 6.68 years) who were hospitalized with TBI, early posttraumatic seizures occurred in 22.5% of children 3 years of age or younger, compared with 7% of children 4 years of age or older [8] .…”

Section: Introductionmentioning

confidence: 99%

Pediatric Posttraumatic Seizures: Epidemiology, Putative Mechanisms of Epileptogenesis and Promising Investigational Progress

Statler¹

2006

Dev Neurosci

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Posttraumatic seizures and epilepsy are common in children experiencing traumatic brain injury and portend worse functional outcome. Unfortunately, the pathogenesis of pediatric posttraumatic seizures and epilepsy remains poorly understood, and no efficacious preventive therapy for post- traumatic epilepsy has been identified. This article reviews the epidemiology of pediatric posttraumatic seizures, discusses prominent putative mechanisms of posttraumatic epileptogenesis and highlights recent promising progress in experimental investigations of posttraumatic seizures and epilepsy.

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“…Post-traumatic seizures affect 12 -35% of children suffering moderate or severe TBI and are associated with worse cognitive and functional outcome, even after adjustment for severity of injury (Chiaretti, et al, 2002;Hahn, et al, 1988;Keenan, et al, 2004;Ong, et al, 1996;Ratan, et al, 1999). Typically, pediatric post-traumatic seizures occur during the initial week post-TBI; however, post-traumatic epilepsy, which is defined as recurrent, unprovoked seizures occurring later than one-week post-TBI, develops in 10 -20% of children after severe TBI (Appleton and Demellweek, 2002;Barlow, et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

Traumatic brain injury during development reduces minimal clonic seizure thresholds at maturity

et al. 2008

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Post-traumatic seizures affect 12 -35% of children after traumatic brain injury (TBI) and are associated with worse cognitive and functional outcome, even after adjustment for severity of injury. Unfortunately, experimental models of pediatric post-traumatic epilepsy are lacking, and pathogenesis remains poorly understood. We have applied a standard model of TBI in immature rats to determine the effect of TBI on electroconvulsive seizure thresholds later in life.Male rats underwent controlled cortical impact to left parietal cortex on post-natal day (PND) 16-18. Hindbrain, forebrain, and limbic seizure thresholds were assessed, respectively, by tonic hindlimb extension (THE), minimal clonic, and partial psychomotor seizure responses during adolescence and at maturity (PND 60 -63). Post-traumatic seizure thresholds were compared to those obtained in age-and litter-matched sham craniotomy and naïve controls.TBI during immaturity had no clear effect on THE seizure thresholds. In contrast, TBI lowered minimal clonic seizure thresholds at maturity (p < 0.05 vs. sham or naïve rats), but not during adolescence. Consequently, minimal clonic seizure thresholds increased with age for sham and naïve rats but remained similar for TBI rats during adolescence and at maturity. TBI also tended to lower partial psychomotor seizure thresholds, which were determined only during adolescence (p < 0.1 vs. naive).Controlled cortical impact causes both focal cortical injury at the site of impact and ipsilateral hippocampal neuronal death. Since minimal clonic seizures are mediated by the forebrain, partial psychomotor seizures by the limbic system, and THE seizures by the brainstem, the observed pattern of changes in post-traumatic seizure thresholds is not surprising. The apparent age-dependent effects of TBI, however, are unexpected and likely due to a combination of attenuated maturational increases

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Early post‐traumatic seizures in children: Clinical and radiological aspects of injury

Abstract: Anticonvulsant prophylaxis to minimize the adverse effects of early seizures in head injury should be considered for young children (less than 2 years old) with subdural haematoma and a prolonged duration of coma. Prompt and effective control of recurrent seizures is recommended.

Cited by 40 publications

References 21 publications

Incidence of seizures on continuous EEG monitoring following traumatic brain injury in children

Incidence of seizures on continuous EEG monitoring following traumatic brain injury in children

Pediatric Posttraumatic Seizures: Epidemiology, Putative Mechanisms of Epileptogenesis and Promising Investigational Progress

Traumatic brain injury during development reduces minimal clonic seizure thresholds at maturity

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