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[Post traumatic partial seizures]
P Carvajal1, C Almárcegui, M J Pablo
1Servicio de Neurofisiología; Hospital Universitario Miguel Servet, Zaragoza, 50009, España.
Insights
This case study highlights epilepsy developing 1.5 years after a severe head injury in a child. The findings question the potential benefit of prophylactic anti-epileptic treatment for post-traumatic epilepsy.
Area of Science:
- Neurology
- Traumatic Brain Injury Research
Background:
- Post-traumatic epilepsy (PTE) accounts for 4% of epilepsy cases and is challenging to prevent.
- Identifying risk factors is crucial for predicting seizure onset after head trauma.
Observation:
- A 7-year-old boy sustained a severe head injury with extensive contusions and intraventricular hemorrhage.
- Neurological sequelae included right hemiplegia, left-sided hypertonia, and bilateral optic nerve atrophy leading to blindness.
- Electroencephalogram (EEG) showed abnormal electrical activity without acute morphology initially.
Findings:
- The patient experienced his first partial seizure 1.5 years post-injury, with an identified epileptogenic focus in the left hemisphere.
- Seven seizures occurred within two years of the head injury.
- No prophylactic anti-epileptic drugs were administered after the initial trauma.
Implications:
- This case suggests a delayed onset of epilepsy following severe traumatic brain injury.
- The discussion explores the potential utility of prophylactic anti-epileptic treatment in high-risk individuals to prevent secondary epilepsy.
Introduction:
Post traumatic epilepsy represents 4% of the prevalence of the disorder and is one of the sequelas which is most difficult to prevent. Risk factors have been described to predict the appearance of seizures.
Clinical Case:
A seven year old boy with a severe head injury was admitted to the Intensive Care Unit. On neuroimaging studies there were multiple foci of contusion, mainly in the left hemisphere, and blood in the III and IV ventricles and frontal horn of the left lateral ventricle. The patient had severe sequelae of head injury with a right spastic hemiplegia and hemiparesia with hypertony of the left side, together with complete blindness of both eyes due to bilateral atrophy of the optic nerve. Serial EEG were done, in which a recording showed alternating periods of hypervoltage grapho elements superimposed on a trace of very low voltage, with continuous activity of low voltage and low frequency. There were no grapho elements with acute morphology. However, the patient had a first partial seizure a year and a half after his head injury. On the EEG an epileptogenic focus was identified in the left hemisphere. Within two years of his head injury he had seven seizures. He had not received prophylactic antiepileptic treatment after the head injury.
Conclusions:
We report a case of epilepsy secondary to a head injury, in which the first seizure occurred one and a half years after injury. In view of the risk factors, we discuss whether prophylactic anti epileptic treatment might have been beneficial.