title: Subclinical early posttraumatic seizures detected by continuous EEG monitoring in a consecutive pediatric cohort.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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).
authors.affiliation: Department of Pediatrics and Adult Neurology, Beaumont Children's Hospital, Oakland University, Royal Oak, Michigan, U.S.A.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Arndt
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lerner
authors.forename: Joyce H
authors.initials: JH
authors.lastname: Matsumoto
authors.forename: Andranik
authors.initials: A
authors.lastname: Madikians
authors.forename: Sue
authors.initials: S
authors.lastname: Yudovin
authors.forename: Hannah
authors.initials: H
authors.lastname: Valino
authors.forename: David L
authors.initials: DL
authors.lastname: McArthur
authors.forename: Joyce Y
authors.initials: JY
authors.lastname: Wu
authors.forename: Michelle
authors.initials: M
authors.lastname: Leung
authors.forename: Farzad
authors.initials: F
authors.lastname: Buxey
authors.forename: Conrad
authors.initials: C
authors.lastname: Szeliga
authors.forename: Michele
authors.initials: M
authors.lastname: Van Hirtum-Das
authors.forename: Raman
authors.initials: R
authors.lastname: Sankar
authors.forename: Amy
authors.initials: A
authors.lastname: Brooks-Kayal
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Giza
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods*; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D013226:Status Epilepticus / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology
chemical_list: D000927:Anticonvulsants
keywords: Children; Clinical neurophysiology; Epilepsy; ICU
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