Research Reports - Posttraumatic seizures in children with severe traumatic brain injury

Childs Nerv Syst. 2012 Nov;28(11):1925-9

Arango JI, Deibert CP, Brown D, Bell M, Dvorchik I, Adelson PD

PURPOSE: Traumatic brain injury (TBI) remains a leading cause of childhood death
and disability worldwide. Seizures are a common complication of TBI and they are
particularly common in pediatric populations. The proper management of children
sustaining severe TBI is still controversial. Our study aims to share our
experience contributing to build evidence for better care.
METHODS: Retrospective chart review was performed on individuals ages 0 to <18
who presented to a level 1 trauma center during a 10-year period with the
diagnosis of severe TBI. Data analyzed included patient's demographics, event
information, clinical and radiological presentation, management, and midterm
follow-up. Presence of seizures was tracked through EEG monitoring, staff
witnessing, or guardian referral.
RESULTS: The incidence of early posttraumatic seizures (EPTS) observed in our
population (19 %) exceeds those previously reported. Such findings likely reflect
the importance of close monitoring including EEG. An association between the
presence of EPTS and the development of late posttraumatic seizures (LPTS) was
evidenced (p = 0.001; 95 % CI 2.2, 16.5), while this association should not be
assumed as a measure of causality, it should be considered for the management of
patients presenting EPTS. Non-accidental trauma and young age were identified as
independent predictors for the development of seizures.
CONCLUSIONS: Seizures are a common complication of severe TBI among children aged
0-3 years. Given the detrimental effects that seizures produce on the injured
brain, close observation and appropriate monitoring with EEG are essential for
the management of children sustaining severe TBI.

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