These two authors contributed equally to the final manuscript.
Full-Length Original Research
Subclinical early posttraumatic seizures detected by continuous EEG monitoring in a consecutive pediatric cohort
Article first published online: 13 SEP 2013
Wiley Periodicals, Inc. © 2013 International League Against Epilepsy
Volume 54, Issue 10, pages 1780–1788, October 2013
How to Cite
Epilepsia, 54(10):1780–1788, 2013
- Issue published online: 1 OCT 2013
- Article first published online: 13 SEP 2013
- Manuscript Accepted: 6 AUG 2013
- Thrasher Research Foundation. Grant Number: NS 058489
- National Institutes of Health (NIH). Grant Numbers: K23 NS051637, P20 NS080199, U01 NS082320, R34 MH089299, R01 NS082649
- Brain Injury Research Center
- Specialized Programs of Translational Research in Acute Stroke (SPOTRIAS) Network
- UCB Pharma
- Lundbeck Pharma
- National Institutes of Neurological Disorders and Stroke (NINDS. Grant Number: NS051710
- Department of Defense CDMRP
- Citizens United for Research in Epilepsy (CURE)
- American Epilepsy Society. Grant Numbers: NS 058489, K23 NS051637, P20 NS080199, U01 NS082320, R34 MH089299, R01 NS082649, NS051710
- National Epifellows Foundation. Grant Numbers: NS 058489, K23 NS051637, P20 NS080199, U01 NS082320, R34 MH089299, R01 NS082649, NS051710
- Colorado Center for Drug Discovery. Grant Number: NS051710
- and Upsher-Smith. Grant Numbers: NS 058489, K23 NS051637, P20 NS080199, U01 NS082320, R34 MH089299, R01 NS082649
- Child Neurology Foundation/Winokur Family Foundation
- Epilepsy Foundation of America
- Today's and Tomorrow's Children Fund
- UCLA Brain Injury Research Center. Grant Number: NS 058489
- Tuberous Sclerosis Alliance, Today's and Tomorrow's Children Fund,
- Novartis Pharmaceuticals Inc
- Department of Defense/Congressionally Directed Medical Research Program
- Clinical neurophysiology;
Traumatic brain injury (TBI) is an important cause of morbidity and mortality in children, and early posttraumatic seizures (EPTS) are a contributing factor to ongoing acute damage. Continuous video-EEG monitoring (cEEG) was utilized to assess the burden of clinical and electrographic EPTS.
Eighty-seven consecutive, unselected (mild – severe), acute TBI patients requiring pediatric intensive care unit (PICU) admission at two academic centers were monitored prospectively with cEEG per established clinical TBI protocols. Clinical and subclinical seizures and status epilepticus (SE, clinical and subclinical) were assessed for their relation to clinical risk factors and short-term outcome measures.
Of all patients, 42.5% (37/87) had seizures. Younger age (p = 0.002) and injury mechanism (abusive head trauma – AHT, p < 0.001) were significant risk factors. Subclinical seizures occurred in 16.1% (14/87), while 6.9% (6/87) had only subclinical seizures. Risk factors for subclinical seizures included younger age (p < 0.001), AHT (p < 0.001), and intraaxial bleed (p < 0.001). SE occurred in 18.4% (16/87) with risk factors including younger age (p < 0.001), AHT (p < 0.001), and intraaxial bleed (p = 0.002). Subclinical SE was detected in 13.8% (12/87) with significant risk factors including younger age (p < 0.001), AHT (p = 0.001), and intraaxial bleed (p = 0.004). Subclinical seizures were associated with lower discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) score (p = 0.002). SE and subclinical SE were associated with increased hospital length of stay (p = 0.017 and p = 0.041, respectively) and lower hospital discharge KOSCHI (p = 0.007 and p = 0.040, respectively).
cEEG monitoring significantly improves detection of seizures/SE and is the only way to detect subclinical seizures/SE. cEEG may be indicated after pediatric TBI, particularly in younger children, AHT cases, and those with intraaxial blood on computerized tomography (CT).