Abstracts

Rationale: Abusive Head Trauma (AHT) is the leading cause of traumatic injury and death to young children and infants. AHT accounts for nearly two-thirds of infant homicides. Infants and children who survive AHT suffer brain injury, eye injuries and fractures in the acute stage. The majority of survivors suffer developmental delays, seizures, motor impairments, feeding difficulties and later behavioral and educational dysfunctions. Victims of abusive head trauma may be at risk for non-convulsive seizures and non-convulsive status epilepticus (NCSE). NCSE is defined as a prolonged electrographic seizure activity resulting in non-convulsive clinical symptoms. Identification of non-convulsive seizures and NCSE changes management in most cases, requiring initiation and/or escalation of anticonvulsant therapy. Further, patients with trauma as an etiology may be at increased risk for permanent structural changes after non-convulsive seizures and NCSE. The primary objective of this study was to determine the prevalence of non-convulsive seizures and NCSE in patients with AHT who underwent electroencephalogram (EEG) monitoring. Methods: The investigators queried an 11 year AHT clinical database. Children under 24 months of age with a diagnosis of AHT were included. Investigators reviewed the medical records of eligible subjects. Presence of EEG findings, including nonconvulsive seizures, nonconvulsive status epilepticus and interictal abnormalities including abnormal background and epileptiform discharges, were identified. Neurodevelopmental outcome was assessed in post injury clinic using formal testing. Results: Over the 11 year collection period, 229 children were identified with the diagnosis of abusive head trauma. Of the 229 children identified, 77 (33.6%) had at least a routine EEG. Sixty-four children (83.1%), had a routine 30 minute EEG. For 14 patients (18.2%), a prolonged continuous EEG was performed, ranging from 11 hours to 120 hours. Of the 77 patients with EEG monitoring, 3 (3.9%) had NCSE and 21 (27.3%) had non-convulsive seizures. Only 13 of 77 patients (16.9) had a normal EEG. Conclusions: This suggests that non-convulsive seizures are relatively common in AHT. Since the prevalence data were derived mostly from a 30 minute EEG, and it is now known that nonconvulsive seizures may not appear until after 24 hours of continuous EEG monitoring, this suggests that continuous EEG should be considered in all cases of suspected abusive head trauma.