Objective:

Background:

Approximately 30% of children with traumatic brain injury develop PTE. Understanding the timing from injury to PTE onset has been difficult, especially for patients with AH.  We previously described 31 patients with AHT and subsequent PTE.  Little is known about the development of PTE in young children with AHTor how such patients respond to treatment. 

Design/Methods:

We utilized a database of 373 patients admitted for AHT to our institution between 2012-2020.  The majority (263/373, 70.5%) were followed in our multidisciplinary clinic (MDC), and 31 (11.8%) developed PTE.  We completed extensive chart review for 23 patients who were less than 3 years old at the time of AHT and developed PTE within 3 years.

Results:

Half (12/23) presented with infantile (epileptic) spasms (IS) – these will be described in a later study.  The other half (11/23) presented with myoclonic seizures, focal seizures, and/or tonic seizures; 2 went on to develop IS.  The median time from AHT to PTE diagnosis and treatment initiation was 259 days (median age 380 days). Many patients demonstrated non-epileptic spells before their diagnosis, but most guardians appropriately recognized epileptic seizures within one week of onset and reached out to Neurology, who arranged confirmation with EEG in 8/12. The majority (10/11) had a least a partial improvement in seizures with the first treatment (levetiracetam 9/11), and two-thirds had fewer than 4 seizures/year by 2 years after PTE diagnosis. 

Conclusions:

atients with AHT are at risk for developing PTE within the first 3 years after their initial injury.  Of the half who did not present with IS, most exhibited at least partial improvement with one or two antiseizure medications after 2 years.  Future studies will evaluate long-term outcomes.