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Published on: June 21, 2019
Occurrence of early epilepsy in children with traumatic brain injury: a retrospective study
Jian Ji1, Su-Yun Qian2, Jun Liu1
1Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 45 Nanlishi Road, Beijing, 100045, China.
Insights
Early post-traumatic seizures (EPTS) affect over a third of pediatric traumatic brain injury (TBI) patients. Fever and open head injuries increase EPTS risk, while surgery and hypertonic saline may be protective.
Area of Science:
- Pediatric Neurology
- Neurotrauma
- Epileptology
Background:
- Early post-traumatic seizures (EPTS) are epileptic seizures occurring within one week of brain injury.
- Understanding risk and protective factors for EPTS is crucial for managing pediatric traumatic brain injury (TBI).
Purpose of the Study:
- To identify risk factors for EPTS in pediatric TBI patients.
- To define protective factors that may prevent EPTS occurrence.
Main Methods:
- A single-center retrospective study was conducted at Beijing Children's Hospital.
- 108 pediatric patients diagnosed with TBI between January 2016 and December 2020 were analyzed.
- Data included patient demographics, injury characteristics, and seizure occurrence.
Main Results:
- The overall incidence of EPTS was 33.98% in the studied cohort.
- Open craniocerebral injury and fever on admission were identified as significant risk factors for EPTS.
- Surgical intervention and hypertonic saline administration were associated with a reduced risk of EPTS.
Conclusions:
- Pediatric TBI patients with fever on admission and open craniocerebral injuries face a higher likelihood of developing EPTS.
- The incidence of EPTS in this cohort was higher than previously reported, highlighting the need for vigilance.
- Prophylactic antiepileptic drug use showed no statistical significance in preventing seizures in post-neurosurgical patients.
Background:
Early post-traumatic seizures (EPTS) refer to epileptic seizures occurring within one week after brain injury. This study aimed to define the risk factors of EPTS and the protective factors that could prevent its occurrence.
Methods:
This is a single-center retrospective study in the PICU, Beijing Children's Hospital. Patients diagnosed with traumatic brain injury (TBI), admitted with and without EPTS between January 2016 and December 2020 were included in the study.
Results:
We included 108 patients diagnosed with TBI. The overall EPTS incidence was 33.98% (35/108). The correlation between EPTS and depressed fractures is positive (P = 0.023). Positive correlations between EPTS and intracranial hemorrhage and subarachnoid hemorrhage had been established (P = 0.011and P = 0.004, respectively). The detection rates of EPTS in the electroencephalogram (EEG) monitoring was 80.00%. There was a significant difference in the EEG monitoring rate between the two groups (P = 0.041). Forty-one (37.86%, 41/108) post-neurosurgical patients were treated with prophylactic antiepileptic drugs (AEDs), and eight (19.51%, 8/41) still had seizures. No statistical significance was noted between the two groups in terms of prophylactic AEDs use (P = 0.519). Logistic regression analysis revealed that open craniocerebral injury and fever on admission were risk factors for EPTS, whereas, surgical intervention and use of hypertonic saline were associated with not developing EPTS.
Conclusions:
Breakthrough EPTS occurred after severe TBI in 33.98% of pediatric cases in our cohort. This is a higher seizure incidence than that reported previously. Patients with fever on admission and open craniocerebral injuries are more likely to develop EPTS.
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