Subclinical early posttraumatic seizures detected by continuous EEG monitoring in a consecutive pediatric cohort

Authors

  • Daniel H. Arndt,

    1. Department of Pediatrics and Adult Neurology, Beaumont Children's Hospital, Oakland University, Royal Oak, Michigan, U.S.A
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    • These two authors contributed equally to the final manuscript.

  • Jason T. Lerner,

    Corresponding author
    1. Division of Pediatric Neurology, Department of Pediatrics, Mattel Children's Hospital – UCLA, Los Angeles, California, U.S.A
    2. UCLA Brain Injury Research Center, Los Angeles, California, U.S.A
    • Address correspondence to Jason T. Lerner, 10833 Le Conte, 22-474 MDCC, Los Angeles, CA 90095, U.S.A. E-mail: jlerner@mednet.ucla.edu

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    • These two authors contributed equally to the final manuscript.

  • Joyce H. Matsumoto,

    1. Division of Pediatric Neurology, Department of Pediatrics, Mattel Children's Hospital – UCLA, Los Angeles, California, U.S.A
    2. UCLA Brain Injury Research Center, Los Angeles, California, U.S.A
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  • Andranik Madikians,

    1. Division of Pediatric Critical Care, Mattel Children's Hospital – UCLA, Los Angeles, California, U.S.A
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  • Sue Yudovin,

    1. Division of Pediatric Neurology, Department of Pediatrics, Mattel Children's Hospital – UCLA, Los Angeles, California, U.S.A
    2. UCLA Brain Injury Research Center, Los Angeles, California, U.S.A
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  • Hannah Valino,

    1. UCLA Brain Injury Research Center, Los Angeles, California, U.S.A
    2. Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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  • David L. McArthur,

    1. UCLA Brain Injury Research Center, Los Angeles, California, U.S.A
    2. Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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  • Joyce Y. Wu,

    1. Division of Pediatric Neurology, Department of Pediatrics, Mattel Children's Hospital – UCLA, Los Angeles, California, U.S.A
    2. UCLA Brain Injury Research Center, Los Angeles, California, U.S.A
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  • Michelle Leung,

    1. UCLA Brain Injury Research Center, Los Angeles, California, U.S.A
    2. Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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  • Farzad Buxey,

    1. UCLA Brain Injury Research Center, Los Angeles, California, U.S.A
    2. Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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  • Conrad Szeliga,

    1. Division of Pediatric Neurology, Department of Pediatrics, Mattel Children's Hospital – UCLA, Los Angeles, California, U.S.A
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  • Michele Van Hirtum-Das,

    1. Division of Pediatric Neurology, Children's Hospital, Los Angeles, California, U.S.A
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  • Raman Sankar,

    1. Division of Pediatric Neurology, Department of Pediatrics, Mattel Children's Hospital – UCLA, Los Angeles, California, U.S.A
    2. UCLA Brain Injury Research Center, Los Angeles, California, U.S.A
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  • Amy Brooks-Kayal,

    1. Division of Pediatric Neurology, Children's Hospital Colorado, Aurora, Colorado, U.S.A
    2. Department of Pediatrics, Neurology and Pharmacological Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
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  • Christopher C. Giza

    1. Division of Pediatric Neurology, Department of Pediatrics, Mattel Children's Hospital – UCLA, Los Angeles, California, U.S.A
    2. UCLA Brain Injury Research Center, Los Angeles, California, U.S.A
    3. Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
    4. Interdepartmental Programs for Neuroscience and Biomedical Engineering, UCLA
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Summary

Purpose

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.

Methods

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.

Key Findings

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).

Significance

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).

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