Abstracts

Rationale: Traumatic brain injury (TBI) is a major cause of lasting disability in infants and children. 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). A thorough characterization of TBI-induced status epilepticus (SE) is an essential starting point for the development of future treatment and prevention strategies.Methods: 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. 34 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.Results: SE was present in 82.3% of infants who had seizures after TBI, compared with 11.7% of older children. Ages of infants with post-TBI SE ranged from 1-11 mo. at the time of injury (mean 3.3 0.7 months). The most common etiology was suspected NAT (85%), followed by fall and MVC. SE was the initial presentation of seizures in 3 patients; 11 patients demonstrated intermittent clinical seizure activity prior to SE onset. Among these patients, the duration from first clinical seizure to SE ranged from 2-24h. SE lasted 20-30 minutes in 4 patients, 30-40 minutes in 3 patients, and >60 minutes in 7 patients, with a maximum duration of approx 36h. 8 patients continued to exhibit intermittent seizure activity up to 3 days after termination of SE. All patients received benzodiazepines as a first line agent followed by fosphenytoin. 8 patients received phenobarbital acutely, and 3 pts received a midazolam drip. Mean number of AED s prior to termination of SE was 2.9 0.3. CT was obtained and was abnormal in 100% of patients, with findings of SDH in 64%, epidural hemorrhage in 7%, SAH in 21%, intraparenchymal hemorrhage in 28% and CVA in 14%. MRI was obtained in 12 patients with findings similar to CT. Follow-up data was available in 11 patients, with duration of follow-up 3 mo. to 5 years (mean 2.5 0.5 years). All 11 patients continued on AED s after hospital discharge, with a mean duration of 1.3 0.5 yr. The most commonly used AED was phenobarbital. 3 of 11 patients continued to have seizures after discharge. Focal neurologic deficits were noted at the final available follow-up visit in 5 patients. Cognitive concerns, including speech and language delays, learning disabilities, and ADHD were noted in 6 patients, and a severe static encephalopathy was noted in 1 patient.Conclusions: To our knowledge, this study is the first characterization of SE after TBI in infants. The data demonstrate a tendency to prolonged seizure activity and support early, aggressive treatment of seizures and continuous EEG monitoring in these patients.