Early posttraumatic seizures in pediatric traumatic brain injury: a multicenter analysis

Abstract

OBJECTIVE Early posttraumatic seizures (EPTSs) in children after traumatic brain injury (TBI) increase metabolic stress on the injured brain. The authors sought to study the demographic and radiographic predictors for EPTS, and to investigate the association between EPTS and death, and between EPTS and poor functional outcomes among children with moderate to severe TBI in Asia. METHODS A secondary analysis of a retrospective TBI cohort among participating centers of the Pediatric Acute & Critical Care Medicine Asian Network was performed. Children < 16 years of age with a Glasgow Coma Scale (GCS) score ≤ 13 who were admitted to pediatric intensive care units between January 2014 and October 2017 were included. Logistic regression analysis was performed to study risk factors for EPTS and to investigate the association between EPTS and death, and between EPTS and poor functional outcomes. Poor functional outcomes were defined as moderate disability, severe disability, and coma as defined by the Pediatric Cerebral Performance Category scale. RESULTS Overall, 313 children were analyzed, with a median age of 4.3 years (IQR 1.8–8.9 years); 162 children (51.8%) had severe TBI (GCS score < 8), and 76 children (24.3%) had EPTS. After adjusting for age, sex, and the presence of nonaccidental trauma (NAT), only younger age was significantly associated with EPTS (adjusted odds ratio [aOR] 0.85, 95% CI 0.78–0.92; p < 0.001). Forty-nine children (15.6%) in the cohort died, and 87 (32.9%) of the 264 surviving patients had poor functional outcomes. EPTS did not increase the risk of death. After adjusting for age, sex, TBI due to NAT, multiple traumas, and a GCS score < 8, the presence of EPTS was associated with poor functional outcomes (aOR 2.08, 95% CI 1.05–4.10; p = 0.036). CONCLUSIONS EPTSs were common among children with moderate to severe TBI in Asia and were associated with poor functional outcomes among children who survived TBI.

Association of Cerebral and Systemic Physiology With Quantitative Electroencephalographic Characteristics of Early Posttraumatic Seizures

“…Given that this is a single-center study, findings may not be generalizable across multiple centers, although we identified that characteristics of our EPTS patient cohort are consistent with those observed from other centers. [3][4][5] Cerebral regional oximetry may not adequately reflect changes in cerebral oxygenation or capture changes reflective of where seizures arose, although we attempted to mitigate against this by investigating probes ipsilateral to seizure onset, as well as performing subgroup analysis of patients with frontal lobe seizures. Intracranial pressure monitoring from an intraparenchymal probe may reflect changes in ICP at the probe site and may not necessarily reflect changes within ictal regions.…”

“…Our findings that EPTS were associated with younger ages and worsened outcomes is consistent with prior literature. 3 Heterogeneity between subjects of EPTS responses on systemic and cerebral physiology raises questions regarding the management to mitigate secondary brain injury. Effective management against EPTS may not need to be simplified into dichotomous decision making regarding whether to treat to seizures aggressively.…”

“…(J Clin Neurophysiol 2024;41: 257-264) P ediatric traumatic brain injury (TBI) is a leading cause of morbidity and mortality, 1 and early management is aimed toward mitigating secondary brain injury. 2 Early posttraumatic seizures (EPTS) are common after pediatric TBI [3][4][5] and are postulated to contribute toward secondary brain injury. Electrographic seizures after acute brain injury have been demonstrated through advanced neuroimaging, and multimodality neurologic monitoring to be associated with disturbances in cerebral metabolism and systemic hemodynamics.…”