Our objectives were to study the incidence and risk factors for PTS, utilization of continuous EEG (cEEG), management with anti-epileptic drugs (AEDs) and clinical outcomes in victims of AHT.
We assembled an eleven-year cohort of children aged 0-3 years, who suffered AHT and were subsequently admitted to an academic children’s hospital. Data pertinent to demographics, clinical features, management and follow up were collected by retrospective chart review and analyzed.
Sixty out of ninety-two AHT victims developed PTS during hospitalization. Mean age was 6 ±5.8 months and predominantly consisted of males (65%). Factors associated with higher likelihood of seizures were subdural hematoma (OR 5.32 [95% CI 1.27-22.2]) and comorbidities like prematurity (OR 5.45 [95% CI 1.16-25.48]). Over 90% of PTS, occurred within a week of hospitalization. Of those, only three cases had purely electrographic seizures. Mean time to cEEG initiation was 14.7 hours. Nearly 50% of seizures continued sub-clinically ,despite clinical control. Although levetiracetam was most commonly used, monotherapy with the same was ineffective in >50%. In comparison to AHT patients without seizures, PTS patients had longer ICU and hospital stays, by 4.1 and 7.8 days respectively. Although, majority (80%) were discharged on AEDs, 40% were weaned off at follow-up. Among PTS patients, mortality rate was <5% with the most common long-term sequelae being developmental delay and epilepsy.
To date, this is the largest cohort study to examine PTS in young AHT victims. While most PTS were clinical and occurred early, cEEG monitoring was essential in detection and treatment of subclinical seizures. Overall, PTS had a good survival rate and outcomes.