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Adding Insult to Injury: Nonconvulsive Seizures in Abusive Head Trauma
Mary V Greiner1, Hansel M Greiner2, Marguerite M Caré3
1Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA mary.greiner@cchmc.org.
Insights
Nonconvulsive seizures are common in abusive head trauma, affecting over a quarter of monitored children. Specific brain imaging findings like subarachnoid hemorrhage increase seizure risk.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Child Abuse Pediatrics
Background:
- Abusive head trauma (AHT) is a significant cause of pediatric brain injury.
- Electroencephalography (EEG) monitoring is crucial for diagnosing seizures in critically ill children.
- Nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) can be challenging to detect in AHT.
Purpose of the Study:
- To determine the prevalence of NCS and NCSE in children with AHT undergoing EEG.
- To identify predictive neuroimaging factors associated with NCS/NCSE in this population.
Main Methods:
- Retrospective chart review of children diagnosed with AHT over 11 years.
- Analysis of EEG monitoring rates, NCS/NCSE occurrence, and neuroimaging findings.
- Statistical association between neuroimaging abnormalities and NCS/NCSE.
Main Results:
- EEG monitoring was performed in 36.8% of 199 AHT patients.
- NCS occurred in 27.4% and NCSE in 4.1% of monitored children.
- Subarachnoid hemorrhage and cortical T2/FLAIR signal abnormalities were significantly linked to NCS/NCSE.
Conclusions:
- Nonconvulsive seizures are a frequent complication of abusive head trauma.
- Certain neuroimaging findings are predictive of NCS/NCSE in AHT patients.
- Increased awareness and EEG monitoring are vital for recognizing NCS/NCSE in AHT.
Abstract:
The primary objectives of this study were to determine the prevalence of nonconvulsive seizures and nonconvulsive status epilepticus in patients with abusive head trauma who underwent electroencephalography (EEG) monitoring and to describe predictive factors for this population. Children with a diagnosis of abusive head trauma were studied retrospectively to determine the rate of EEG monitoring, the rate of nonconvulsive seizures and nonconvulsive status epilepticus, and the associated neuroimaging findings. Over 11 years, 73 of 199 (36.8%) children with abusive head trauma had electroencephalography monitoring performed. Of these, 20 (27.4%) had nonconvulsive seizures and 3 (4.1%) had nonconvulsive status epilepticus. The presence of subarachnoid hemorrhage and cortical T2 / fluid-attenuated inversion recovery signal abnormalities were both significantly associated with the presence of nonconvulsive seizures / nonconvulsive status epilepticus. Nonconvulsive seizures are relatively common in abusive head trauma and may go unrecognized. Specific neuroimaging characteristics increase the likelihood of nonconvulsive seizures on EEG.
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