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- Title
Subclinical early posttraumatic seizures detected by continuous EEG monitoring in a consecutive pediatric cohort.
- Authors
Arndt, Daniel H.; Lerner, Jason T.; Matsumoto, Joyce H.; Madikians, Andranik; Yudovin, Sue; Valino, Hannah; McArthur, David L.; Wu, Joyce Y.; Leung, Michelle; Buxey, Farzad; Szeliga, Conrad; Hirtum‐Das, Michele; Sankar, Raman; Brooks‐Kayal, Amy; Giza, Christopher C.
- Abstract
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).
- Subjects
BRAIN injuries; SPASMS; ELECTROENCEPHALOGRAPHY; JUVENILE diseases; DISEASE risk factors; TOMOGRAPHY; HOSPITAL care
- Publication
Epilepsia (Series 4), 2013, Vol 54, Issue 10, p1780
- ISSN
0013-9580
- Publication type
Article
- DOI
10.1111/epi.12369