In the first study to utilize continuous EEG monitoring (cEEG) to define the incidence of early post traumatic seizures (EPTS) in children compared to published rates in adults, investigators at the University of Colorado followed pediatric patients with moderate to severe traumatic brain injury (TBI) admitted to Denver Children's Hospital over a nine month period. Their report presented here at the 64th American Epilepsy Society Annual Meeting suggests that the incidence of EPTS in children with moderate to severe TBI is more than twice the rate in adults. (Platform C.05)
The children, ranging in age from one month to 16 years, had experienced brain trauma from motor vehicle accidents, non-accidental trauma, falls, blunt injury, and other causes. They were observed for clinical seizures and monitored with cEEG to capture sub-clinical episodes occurring within seven days post-injury.
More than half of the children (55.6%) had EPTS. Children under two years of age and those subjected to non-accidental trauma were most susceptible to the early seizures. However, EPTS did not influence the short term outcome measures of ICU/hospital length of stay and duration of intubation.
There was a high rate of status epilepticus, prolonged and potentially injurious seizures, experienced in this study by 44.4% of the children. The incidence of epileptiform discharges (abnormal EEG activity signifying the potential for seizures to occur) was five-fold higher in children than adults.
"The high rate of sub-clinical seizures that would have otherwise been missed without cEEG monitoring, especially in younger children and those with non-accidental trauma, was very impressive," says lead author Daniel Arndt, M.D. "This study highlights the benefits of cEEG monitoring acutely after pediatric moderate-severe TBI. Further studies are indicated to verify these findings, determine if EPTS influence long-term outcome, and if treating or preventing the EPTS or subclinical seizures improves outcome."