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Published on: June 21, 2019
Pharmacological management of post-traumatic seizures in a South African paediatric intensive care unit
1Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Post-traumatic seizures (PTS) are common in children with severe traumatic brain injury (TBI). Management of PTS varies, highlighting the need for further research to optimize care and minimize secondary brain injury in pediatric intensive care units.
Area of Science:
- Pediatric Intensive Care
- Neurology
- Trauma Surgery
Background:
- Traumatic brain injury (TBI) is a significant cause of pediatric intensive care unit (PICU) admissions in South Africa.
- Post-traumatic seizures (PTS) are a critical complication of TBI, necessitating effective prevention and management to avoid secondary brain injury.
Purpose of the Study:
- To characterize the demographics of pediatric patients admitted to a South African PICU following TBI.
- To describe the incidence and clinical features of post-traumatic seizures (PTS) in this population.
- To evaluate the prophylactic and therapeutic strategies employed for PTS management within the PICU.
Main Methods:
- A retrospective chart review was conducted over three years (July 2015 - June 2018) at the PICU of Chris Hani Baragwanath Academic Hospital.
- Data collected included patient demographics, TBI characteristics, seizure occurrence, and anti-epileptic drug (AED) management.
- Analysis focused on the incidence of early and late PTS, seizure types, and treatment outcomes.
Main Results:
- Severe TBI was the primary reason for PICU admission, predominantly due to mechanical injury (89%).
- Overall PTS incidence was 43%, with higher rates in younger children (<2 years).
- Significant variability was observed in AED prophylaxis and maintenance therapy, with only 56% of drug levels within the target range.
Conclusions:
- Post-traumatic seizures (PTS) represent a frequent complication of severe TBI in children.
- Current practices for PTS prophylaxis and maintenance therapy show considerable variation, including agent choice, dosage, and drug monitoring.
- Further high-level research is essential to establish evidence-based guidelines for optimizing PTS management in pediatric TBI patients.
Background:
Traumatic brain injury (TBI) is a common cause of paediatric intensive care unit (PICU) admissions in South Africa. Optimal care of these patients includes the prevention and control of post-traumatic seizures (PTS) in order to minimise secondary brain injury.
Objectives:
To describe the demographics of children admitted to a South African PICU, to describe the characteristics of PTS, and to describe the prophylactic and therapeutic management of PTS within the unit.
Methods:
A 3-year retrospective chart review was conducted at the PICU of the Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Johannesburg, from 1 July 2015 to 30 June 2018.
Results:
Seventy-eight patients were admitted to the PICU, all with severe TBI. A total of 66 patient files were available for analysis. The median age of admission was 6 years (interquartile range (IQR) 4 - 9) with the majority of trauma secondary to mechanical injury (89%). Prophylactic anti-epileptic drugs (AEDs) were initiated in 44 (79%) patients. Early PTS occurred in 11 (25%) patients who received prophylaxis and 4 (33%) who did not. Three (5%) patients developed late PTS, resulting in an overall incidence of PTS of 43%. The most common seizure type was generalised tonic clonic (82%). Children diagnosed with PTS were a median of 2 years younger than those without PTS, with increased prevalence of seizures (83% v. 38%) in children below 2 years of age. Maintenance therapy was initiated in all patients consistent with recommended dosages. Of the total 167 anti-epileptic levels taken during maintenance, only 56% were within target range. Of the initial 78 patients, 8 died (10%). The median length of stay was 7 (IQR 5 - 12) and 8 (IQR 8 - 24) days longer in ICU and hospital respectively, in children with PTS.
Conclusion:
PTS is a frequent complication of severe TBI in children. There was considerable variation in the approach to both prophylaxis and maintenance therapy of PTS in terms of choice of agent, dosage, frequency of drug monitoring and approach to subtherapeutic levels. It is clear that more high-level studies are required in order to better inform these practices.
Contributions Of The Study:
To the best of our knowledge, this article represents the first description of incidence and management practices of paediatric post traumatic seizures.
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