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Use of a Wireless Video-EEG System to Monitor Epileptiform Discharges Following Lateral Fluid-Percussion Induced Traumatic Brain Injury
Published on: June 21, 2019
Continuous Electroencephalographic Characterization of Late Seizures in Traumatic Brain Injury With a Biphasic
Kenta Ochiai1, Ken Imai2, Haruna Yoshikawa2
1Tokyo Metropolitan Children's Medical Center, Department of Neurology, Fuchu, Tokyo, Japan; Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan.
Insights
Late seizures in infants with traumatic brain injury (TBIRD) are often undetected without continuous electroencephalography (cEEG). cEEG monitoring is crucial for timely diagnosis and management of these occult seizures.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Neuroimaging
Background:
- Infantile traumatic brain injury (TBI) can present with a biphasic clinical course and late reduced diffusion (TBIRD).
- Late-onset seizures are a significant concern in infants with TBIRD.
Purpose of the Study:
- To characterize late seizures in infants with TBIRD using continuous electroencephalography (cEEG).
- To evaluate the utility of cEEG in identifying occult seizures in this population.
Main Methods:
- Retrospective case series of seven infants (3-9 months) with TBIRD.
- Analysis of clinical data, diffusion-weighted magnetic resonance imaging, and cEEG recordings.
- Review by pediatric neurologists using standardized critical care electroencephalography terminology.
Main Results:
- Seizures emerged 3-5 days post-injury, initially as electrographic seizures without clinical signs.
- Seizures evolved into electrographic status epilepticus in five patients.
- Seizure origins included lateralized periodic discharges or rhythmic delta activity, often in the occipital region or near the hematoma.
Conclusions:
- Late seizures in infantile TBIRD are frequently occult and may be missed without cEEG.
- cEEG monitoring is essential for early recognition, diagnosis, and management of TBIRD-associated seizures.
Background:
This study aimed to characterize late seizures in infants with traumatic brain injury with a biphasic clinical course and late reduced diffusion (TBIRD) using continuous electroencephalography (cEEG).
Methods:
The present, single-center, retrospective case series was conducted at a single center between 2020 and 2025. TBIRD was defined as early post-traumatic seizures or impaired consciousness, seizure onset 3-6 days after injury, and the late appearance of high signal intensity areas in the subcortical white matter on diffusion-weighted magnetic resonance imaging. cEEG recordings and clinical and imaging data were reviewed by pediatric neurologists using standardized critical care electroencephalography terminology.
Results:
Seven infants aged 3-9 months (median age: 5 months) presenting with early convulsive status epilepticus, acute subdural hematoma, and a high Tada score (≥4) met the inclusion criteria. The seizures emerged 3-5 days after injury and initially occurred as electrographic seizures without clinical correlates, clustered in all the patients, and evolved into electrographic status epilepticus in five patients. The seizures typically arose from lateralized periodic discharges or lateralized rhythmic delta activity, most often in the occipital region or in the areas adjacent to the hematoma.
Conclusions:
These findings indicated that late seizures in infantile TBIRD are frequently occult at the bedside and may be overlooked without cEEG. cEEG monitoring may facilitate earlier recognition of late seizures and enable timely diagnosis and management of TBIRD.
Related Concept Videos
01:20Seizures l: Introduction
01:28Traumatic Brain Injury l: Introduction