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Electroencephalogram pattern predicting neurological outcomes of children with seizures secondary to abusive head
Cheng-Che Chou1, Ju-Yin Hou2, I-Jun Chou2
1Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taiwan.
Insights
Abusive head trauma (AHT) in children can lead to seizures and varying EEG patterns. Diffuse cortical dysfunction on EEG, focal seizures, and low GCS scores are linked to poor neurological outcomes in AHT patients.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Child Abuse Research
Background:
- Abusive head trauma (AHT) presents with variable clinical signs, including seizures and electroencephalogram (EEG) changes.
- EEG background wave alterations reflect cortical function in children, necessitating investigation into their prognostic value in AHT.
Purpose of the Study:
- To determine if EEG background, epileptiform discharges, and seizure patterns correlate with patient outcomes in abusive head trauma.
- To assess the association between acute-stage EEG characteristics and neurological outcomes in children with AHT-related seizures.
Main Methods:
- Retrospective evaluation of 50 children under 6 years hospitalized with AHT between 2000 and 2010.
- Utilized seizure type and acute EEG findings to predict adverse neurological outcomes, assessed using the KOSCHI scale and neurological impairment at 6 months post-discharge.
Main Results:
- Higher mortality observed in AHT children with apnea, cardiac arrest, reverse blood flow, or skull fracture, even without seizures.
- Persistent seizures for one week correlated with poor neurological outcomes; initial seizures were more frequent in younger children.
- Focal seizures, diffuse cortical dysfunction on acute EEG, and low Glasgow Coma Scale (GCS) scores significantly predicted poor 6-month outcomes, including motor, speech, and cognitive deficits.
Conclusions:
- Diffuse cortical dysfunction on acute-stage EEG, in conjunction with low GCS scores and focal seizures, indicates a higher risk of poor outcomes and neurological deficits in children with AHT.
Background:
The clinical presentations of abusive head trauma can abruptly worsen, so the occurrence of seizures and changes of EEG can be variable according to patients' conditions. Since the changes of EEG background waves reflect the cortical function of children, we aimed to find out whether the timing of EEG background, epileptiform discharges and seizure patterns were associated with the outcomes of patients with AHT.
Material And Methods:
Using seizure type and acute stage electroencephalographic (EEG) characteristics to assess adverse neurological outcomes in children with seizures secondary to abusive head trauma (AHT). Children who were hospitalized with AHT at a tertiary referral hospital from October 2000 to April 2010 were evaluated retrospectively. A total of 50 children below 6 years of age admitted due to AHT were included. KOSCHI outcome scale was used to evaluate the primary outcome and neurological impairment was used as secondary outcome after 6 months discharge.
Results:
Children with apnea, cardiac arrest, reverse blood flow and skull fracture in clinic had a higher mortality rate even in the no-seizure group (3/5 [60%] vs. 3/45 [6.7%], odds ratio [OR] = 11; 95% CI = 2.3-52; p = 0.025). Seizure occurrence reduced mostly at the second day after admission in seizure groups; but children with persistent seizures for 1 week showed poor neurological outcomes. The occurrence of initial seizure was frequency associated with younger age; focal seizure, diffuse cortical dysfunction in acute-stage EEG, and low Glasgow Coma Scale (GCS) score were significantly related to poor outcomes after 6 months. Diffuse cortical dysfunction was also associated with motor, speech, and cognitive dysfunction.
Conclusions:
Diffuse cortical dysfunction in acute-stage EEG combined with low GCS score and focal seizure may related to poor outcomes and neurological dysfunctions in children with AHT.
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