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Benign focal epileptiform discharges in children after severe head trauma: prognostic value and clinical course
G Wohlrab1, B Schmitt, E Boltshauser
1Department of Clinical Neurophysiology and Neurology, University Children's Hospital, Zürich, Switzerland.
Insights
Benign focal epileptiform discharges (BFED) in children after severe head trauma (SHT) generally resolve favorably, similar to benign focal epilepsy. These EEG findings in children with SHT warrant management aligned with established protocols for benign focal epilepsy.
Area of Science:
- Pediatric Neurology
- Neurophysiology
- Traumatic Brain Injury
Background:
- Severe head trauma (SHT) in children can lead to post-traumatic epilepsy.
- Electroencephalogram (EEG) findings, including epileptiform discharges, are crucial for diagnosis and prognosis.
Purpose of the Study:
- To evaluate the occurrence and long-term prognosis of benign focal epileptiform discharges (BFED) detected via EEG in children following severe head trauma.
- To compare the outcomes of BFED with potentially symptomatic epileptic foci.
Main Methods:
- A cohort of 828 children with SHT was retrospectively analyzed.
- EEG data from 47 children with epileptic foci were categorized into BFED (Group I) and suspected symptomatic (Group II).
- Analysis included epilepsy course, EEG discharge patterns, neuroimaging, neurological outcomes, and school adjustment.
Main Results:
- BFED (Group I) and symptomatic foci (Group II) showed varying onset and resolution times for epileptic discharges.
- Epilepsy developed in 14% of Group I and 48% of Group II, with drug-refractory epilepsy in 6 children of Group II.
- CT lesions were observed in both groups, ipsilateral to the epileptic focus.
- School attendance rates were comparable between groups (67% vs. 48%).
Conclusions:
- Benign focal epileptiform discharges in post-SHT EEGs exhibit a favorable prognosis, mirroring that of classic benign focal epilepsy.
- Management strategies for BFED post-SHT should align with those for benign focal epilepsy.
- Early identification and appropriate management are key for optimizing outcomes in children with post-traumatic epilepsy.
Purpose:
To assess the occurrence and prognosis of benign focal epileptiform discharges (BFED) in EEG after severe head trauma (SHT) in children.
Methods:
Between January 1987 and December 1994, 47 of 828 children with anamnestic SHT showed a single or dominant epileptic focus in EEG. Spike wave localization and morphology were either suggestive for BFED (group I, 21 children) or were suspected to be symptomatic (group II, 26 children). We analyzed the course of epilepsy and epileptic discharges in EEG, neuroradiologic findings, neurologic outcome, and school adjustment.
Results:
After SHT, spike waves appeared immediately (within 72 h) or delayed (maximum 7 years) and disappeared between ages 3 and 14 years in 14 children of group I and between ages 8 and 23 years in 10 of group II. Children with persistent spike waves in group I were all younger than 14 years; in group II, seven were older than 15 years. Computed tomographic (CT) lesions, ipsilateral to the epileptic focus, were seen in 10 children of group I and 15 of group II. Early seizures occurred in nine children of group I and eight of group II and late-onset seizures in one of group I and nine of group II (p = 0.028). Epilepsy developed in three children of group I and 12 of group II and was drug refractory in six children of group II, all with persistent epileptic foci. Regular schools were attended by 14 (67%) children in group I and 12 (48%) of group II.
Conclusions:
Benign focal epileptiform discharges in posttraumatic EEGs have the same favorable prognosis as in benign focal epilepsy and should be handled as recommended for classic benign focal epilepsy.