Understanding Post-traumatic Epilepsy in Pediatric Patients with Abusive Head Trauma
Ricka Messer1, Casey Madison1, Sarah Graber1, Amy Connery1
1Children's Hospital Colorado
Objective:
To characterize risk factors, timing, semiology, and severity of post-traumatic epilepsy (PTE) in children with abusive head trauma (AHT).
Background:
Studies suggest that approximately 30% of children with AHT develop PTE within 2-5 years. However, understanding the timing from injury to PTE onset has been complicated by small sample size or utilization of diagnosis codes. In addition, little is known about the types of seizures or the response to treatment in PTE after AHT. The relationship between early post-traumatic seizures (EPTS) and later PTE is also poorly understood.
Design/Methods:
We utilized a database of 373 patients admitted to our institution between 2012-2020 for AHT to determine injury characteristics, admission characteristics, and post-discharge outcomes. We will complete extensive chart review for the 31 patients who were diagnosed with epilepsy.
Results:
Of the 373 patients, the majority were males (64.1%), and the median age at abusive head trauma diagnosis was 4.9 months. Approximately 70% had an EEG during the admission, with 43.9% of those patients demonstrating EPTS. The majority of patients (263/373, 70.5%), were followed in our multidisciplinary clinic (MDC), but 10.5% died and 19% were lost to follow-up. Of the patients who followed up in MDC through March 2023, 31 (11.8%) were diagnosed with PTE, with infantile spasms, myoclonic seizures, focal seizures, and/or tonic seizures. During the admission, 30/31 patients had moderate-severe traumatic brain injury and were placed on EEG, and 20/31 (64.5%) required continuous antiseizure medication infusions due to refractory EPTS.
Conclusions:
Patients with AHT are at high risk for EPTS and later PTE, with a variety of epileptic seizure types. Interestingly, not all patients with PTE required continuous infusions to control their EPTS. Next steps will include determining the median time to PTE diagnosis, distribution of seizure types, and response to treatment.