1. Status Epilepticus Presenting After Traumatic Brain Injury in Infants Kurz, J. E.1; Zelleke, T.1; Carpenter, J.1; Dean, N.2; Singh, J.1; Kadom, N.3; Gaillard, W. D.1 Children’s National Medical Center, Washington, DC. Departments of Neurology1, Critical Care Medicine2, and Radiology3
Introduction
Traumatic brain injury (TBI) is a major cause of lasting disability in infants and children1. One factor contributing to poor outcomes is the presence of post-traumatic seizures. The rate of early post-traumatic seizures is increased among children under 2 years of age and among children experiencing non-accidental trauma (NAT)2,3. A thorough characterization of TBI-induced status epilepticus (SE) is an essential starting point for the development of future treatment and prevention strategies.
Figure 1: Infants with post-traumatic seizures had a higher rate of SE than older children. SE was present in 82.3% of infants who had seizures after TBI, compared with 11.7% of older children. (P<0.01, Fisher’s exact test, RR 5.25, 95%CI )
Figure 4: Duration of post-traumatic SE in infants. Duration ranged from 20 minutes to a maximum duration of approx 36h. Additionally, 8 patients continued to exhibit intermittent seizure activity up to 3 days after termination of SE.
Methods
Table 1: Abnormal imaging findings were present in 100% of patients. Findings of CT were similar to MRI.
Patients were identified from a prospective database that collects demographic information, seizure characteristics, medical and family history, physical exam, lab data, EEG and CT/MRI on all patients presenting with new-onset seizures at a tertiary-care pediatric hospital patients were identified with new-onset seizures after TBI, 17 of whom were between the ages of 1 and 12 months. 14 of these 17 presented with SE after TBI. Follow-up data was obtained through retrospective chart-review of the previously identified patients
Table 2: Follow-up data for infants with post-traumatic SE
Conclusions
Infants with new-onset seizures after TBI were more likely to develop SE than older children.
•Infants demonstrated a tendency to prolonged seizure activity, typically early in their presentation.
• All infants that developed SE after TBI had marked traumatically-induced abnormalities on CT and MRI imaging.
• The data support early, aggressive treatment of seizures after TBI in this age group, particularly when imaging abnormalities are present. Continuous EEG monitoring should be considered in these patients.
Figure 3: Infants developed SE within 24h of their first seizure. 3 infants presented to the emergency department in SE. The remaining infants had 1 or several brief seizures before developing continuous seizure activity.
Figure 5: Anti-epileptic therapy for infants with post-traumatic SE. All patients received benzodiazepines as a first line agent followed by fosphenytoin. Mean number of AED’s prior to termination of SE was 2.9 ± 0.3.
Figure 2: Age distribution of infants with post-traumatic SE and characteristics of patients. Infants trended toward the younger end of the age range. Suspected NAT was the most common etiology of injury.
1. Langlois, J. A., W. Rutland-Brown, et al. (2004). Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. Atlanta, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
2. Ong, L. C., M. K. Dhillon, et al. (1996). "Early post-traumatic seizures in children: clinical and radiological aspects of injury." J Paediatr Child Health 32(2):
3. Barlow, K. M., J. J. Spowart, et al. (2000). "Early posttraumatic seizures in non-accidental head injury: relation to outcome." Dev Med Child Neurol 42(9):
4. Singh, R. K., S. Stephens, et al. (2010). "Prospective study of new-onset seizures presenting as status epilepticus in childhood." Neurology 74(8):