Associations between Electroencephalographic Variables, Early Post-Traumatic Seizure Risk, and Outcomes following
Taylor E Nickerson1, Lauren Villo2, Mariah Eisner3
1Division of Critical Care Medicine, Department of Pediatrics, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, United States.
Insights
Early post-traumatic seizures (PTS) in children with traumatic brain injury (TBI) are linked to poor outcomes. Continuous EEG (cEEG) findings like interictal abnormalities and lateralized periodic discharges (LPDs) predict PTS risk.
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.
Abstract:
Early post-traumatic seizures (PTS) are associated with worse outcomes in children with traumatic brain injury (TBI). Our aim was to identify the association between continuous electroencephalogram (cEEG) characteristics and early PTS risk following pediatric severe TBI. We also evaluated the relationship between cEEG background features and outcomes. A single-center retrospective cohort study was performed on children between 0 and 18 years of age admitted to the pediatric intensive care unit from 2016 to 2019 with severe TBI and cEEG monitoring within 7 days of injury. Raw cEEG tracings were reviewed by an epileptologist in accordance with American Clinical Neurophysiology Society (ACNS) Critical Care EEG terminology. Univariate comparisons were made between children with and without early PTS, as well as between those with and without varying cEEG background features. Eighteen children (31%) of the 59 included had early PTS. Interictal abnormalities, inclusive of sporadic spikes and sharp waves, rhythmic delta activity, or lateralized periodic discharges (LPDs) were more common among children with seizures (100 vs. 22%; p < 0.01). LPDs were also more common in the seizure group (44 vs. 2%; p < 0.01). Background discontinuity was associated with worse Glasgow Outcome Scale-Extended Pediatric Version (GOS-E Peds) scores at discharge and 3-, 6-, and 12-month post-discharge ( p < 0.01). Lack of reactivity was also associated with worse GOS-E Peds scores at 3-, 6-, and 12-month post-discharge ( p < 0.01). Interictal abnormalities and LPDs were each associated with early PTS following pediatric severe TBI. Larger studies should evaluate if high-risk patients would benefit from prolonged cEEG monitoring and/or more aggressive anti-seizure prophylaxis. Discontinuity and lack of variability were associated with worse outcomes. Future studies should attempt to clarify their role as potential early markers of prognosis.
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