Associations between Electroencephalographic Variables, Early Post-Traumatic Seizure Risk, and Outcomes following...

Area of Science:

• Pediatric Neurology
• Neurocritical Care
• Epileptology

Background:

• Early post-traumatic seizures (PTS) negatively impact outcomes in pediatric severe traumatic brain injury (TBI).
• Continuous electroencephalogram (cEEG) monitoring is crucial for detecting seizures and assessing brain function in critically ill children.
• Understanding cEEG characteristics associated with early PTS and prognosis is vital for optimizing patient management.

Purpose of the Study:

• To identify associations between cEEG characteristics and the risk of early PTS in children with severe TBI.
• To evaluate the relationship between cEEG background features and patient outcomes following severe TBI.

Main Methods:

• Retrospective cohort study of 59 children (0-18 years) with severe TBI and cEEG monitoring within 7 days of injury.
• cEEG tracings analyzed by an epileptologist using American Clinical Neurophysiology Society (ACNS) Critical Care EEG terminology.
• Univariate comparisons between children with and without early PTS, and between varying cEEG background features and outcomes.

Main Results:

• Eighteen children (31%) experienced early PTS.
• Interictal abnormalities (including LPDs) were significantly more common in children with early PTS (100% vs. 22%, p < 0.01).
• Background discontinuity and lack of reactivity on cEEG were associated with worse Glasgow Outcome Scale-Extended Pediatric Version (GOS-E Peds) scores post-discharge.

Conclusions:

• Interictal abnormalities and LPDs on cEEG are associated with early PTS in pediatric severe TBI.
• Background discontinuity and lack of reactivity may serve as early prognostic markers for worse outcomes.
• Further research is warranted to explore prolonged cEEG monitoring and anti-seizure prophylaxis for high-risk patients.