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Inducing Post-Traumatic Epilepsy in a Mouse Model of Repetitive Diffuse Traumatic Brain Injury
Published on: February 10, 2020
Posttraumatic epilepsy in critically ill children with traumatic brain injury
Nazan Ulgen Tekerek1,2, Oguz Dursun3, Nazik Asilioglu Yener4
1Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey. nazanulgen@hotmail.com.
Insights
Multiple intracranial hemorrhages and seizures during intensive care unit admission are key risk factors for developing posttraumatic epilepsy (PTE) in children with traumatic brain injury (TBI). Early identification aids in managing PTE risk.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Traumatology
Background:
- Posttraumatic epilepsy (PTE) is a significant complication following traumatic brain injury (TBI).
- Identifying risk factors for PTE is crucial for timely intervention and improved patient outcomes in pediatric intensive care settings.
Purpose of the Study:
- To determine the clinical, laboratory, and radiological factors associated with the development of PTE in pediatric patients.
- To identify independent risk factors for PTE in children admitted to the intensive care unit for TBI.
Main Methods:
- A multicenter descriptive cross-sectional cohort study involving 477 pediatric patients with TBI.
- Data collected included demographic, clinical, and radiological parameters, with neurologist evaluation for PTE within 6 months post-trauma.
- Logistic regression analysis was used to identify independent risk factors for PTE.
Main Results:
- Patients with epilepsy had higher scores for trauma severity (Rotterdam, PRISM III, GCS), longer hospitalizations, and increased need for mechanical ventilation.
- Severe TBI, cerebral edema, increased intracranial pressure, blood transfusions, multiple intracranial hemorrhages, and intubation were associated with higher epilepsy rates.
- Intracranial hemorrhage in multiple brain compartments (OR 6.13) and clinical seizures (OR 9.75) were independent predictors of PTE.
Conclusions:
- Multiple intracranial hemorrhages and clinical seizures during intensive care unit admission are independent risk factors for PTE in pediatric TBI patients.
- These findings highlight the importance of vigilant monitoring and management of these factors to mitigate PTE development.
Purpose:
The aim of this study was to determine the clinical, laboratory, and radiological factors related with posttraumatic epilepsy (PTE).
Methods:
The study is a multicenter descriptive cross-sectional cohort study. Children who followed up for TBI in the pediatric intensive care unit between 2014 and 2021 were included. Demographic data and clinical and radiological parameters were recorded from electronic case forms. All patients who were in the 6-month posttraumatic period were evaluated by a neurologist for PTE.
Results:
Four hundred seventy-seven patients were included. The median age at the time of trauma was 66 (IQR 27-122) months, and 298 (62.5%) were male. Two hundred eighty (58.7%) patients had multiple traumas. The mortality rate was 11.7%. The mean duration of hospitalization, pediatric intensive care unit hospitalization and mechanical ventilation, Rotterdam score, PRISM III score, and GCS at admission were higher in patients with epilepsy (p < 0.05). The rate of epilepsy was higher in patients with severe TBI, cerebral edema on tomography and clinical findings of increased intracranial pressure, blood transfusion in the intensive care unit, multiple intracranial hemorrhages, and intubated patients (p < 0.05). In logistic regression analysis, the presence of intracranial hemorrhage in more than one compartment of the brain (OR 6.13, 95%CI 3.05-12.33) and the presence of seizures (OR 9.75, 95%CI 4.80-19.83) were independently significant in terms of the development of epilepsy (p < 0.001).
Conclusions:
In this multicenter cross-sectional study, intracranial hemorrhages in more than one compartment and clinical seizures during intensive care unit admission were found to be independent risk factors for PTE development in pediatric intensive care unit patients with TBI.
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