Posttraumatic epilepsy in intensive care unit–treated pediatric traumatic brain injury patients
Open Access
- 28 March 2020
- Vol. 61 (4), 693-701
- https://doi.org/10.1111/epi.16483
Abstract
Objective Posttraumatic epilepsy (PTE) is a well‐described complication of traumatic brain injury (TBI). The majority of the available data regarding PTE stem from the adult population. Our aim was to identify the clinical and radiological risk factors associated with PTE in a pediatric TBI population treated in an intensive care unit (ICU). Methods We used the Finnish Intensive Care Consortium database to identify pediatric (<18 years) TBI patients treated in four academic university hospital ICUs in Finland between 2003 and 2013. Our primary outcome was the development of PTE, defined as the need for oral antiepileptic medication in patients alive at 6 months. We assessed the risk factors associated with PTE using multivariable logistic regression modeling. Results Of the 290 patients included in the study, 59 (20%) developed PTE. Median age was 15 years (interquartile range [IQR] 13‐17), and 80% had an admission Glasgow Coma Scale (GCS) score ≤12. Major risk factors for developing PTE were age (adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.00‐1.16), obliterated suprasellar cisterns (OR 6.53, 95% CI 1.95‐21.81), and an admission GCS score of 9‐12 in comparison to a GCS score of 13‐15 (OR 2.88, 95% CI 1.24‐6.69). Significance We showed that PTE is a common long‐term complication after ICU‐treated pediatric TBI. Higher age, moderate injury severity, obliterated suprasellar cisterns, seizures during ICU stay, and surgical treatment are associated with an increased risk of PTE. Further studies are needed to identify strategies to decrease the risk of PTE.Funding Information
- Medicinska Understödsföreningen Liv och Hälsa
- Finska Läkaresällskapet
This publication has 33 references indexed in Scilit:
- Do children really recover better? Neurobehavioural plasticity after early brain insultBrain, 2011
- Antiepileptic drugs and brain developmentEpilepsy Research, 2010
- The Nordic Countries as a Cohort for Pharmacoepidemiological ResearchBasic & Clinical Pharmacology & Toxicology, 2010
- Epilepsy after head injury: An overviewEpilepsia, 2009
- Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patientsBMJ, 2008
- Seizures and Antiepileptic Drugs: Does Exposure Alter Normal Brain Development?Epilepsia, 2006
- Analyzing risk factors for late posttraumatic seizures: A prospective, multicenter investigationArchives of Physical Medicine and Rehabilitation, 2003
- Post-traumatic epilepsy in children requiring inpatient rehabilitation following head injuryJournal of Neurology, Neurosurgery & Psychiatry, 2002
- Long-Term Prognosis of Seizures with Onset in ChildhoodThe New England Journal of Medicine, 1998
- A Population-Based Study of Seizures after Traumatic Brain InjuriesThe New England Journal of Medicine, 1998