Abstracts

Rationale: The incidence of pediatric abusive head trauma (PAHT) in children under five years of age in the United States has been rising, contributing to substantial morbidity, mortality, and healthcare costs. Children with PAHT are at high risk for developing acute post-traumatic seizures (PTS) and post-traumatic epilepsy (PTE). Yet, limited research focuses on the factors influencing PTS and PTE-related outcomes in PAHT.

Methods: This retrospective study reviewed medical records of children who sustained non-fatal PAHT and were admitted to Children’s Wisconsin Hospital from 2012 to 2021 and had follow-up for a minimum of 12 months. Data collected included clinical details, lab and imaging results, neurophysiological findings, and seizure-related outcomes.


Results: This study included 71 patients (36.6% female). The median age at hospitalization was 4.39 months (IQR 2.30-8.47). The severity of pediatric traumatic brain injury was classified as mild in 50.0%, moderate in 24.3%, and severe in 25.7%. Fractures were observed in various locations: skull (29.6%), vertebrae (4.2%), extremities (19.7%), and ribs (19.7%). All patients underwent neuroimaging (85.9% undergoing CT scans; 93.0% undergoing MRIs). Types of intracranial hemorrhage included epidural hemorrhage (3, 5.0%), subdural hemorrhage (50, 83.3%), subarachnoid hemorrhage (17, 28.3%), and intraparenchymal hemorrhage (2, 3.3%). Additionally, 21 patients (30.0%) of the cohort showed features of hypoxic-ischemic injury, and cerebral edema was observed in 29 patients.

Post-traumatic seizures were reported in 61.9% of the cohort, with the majority (n=30) occurring within the first 24 hours post-injury. Seizures were clinically categorized as generalized (17.1%), focal (20.0%), status epilepticus (21.4%), unknown (12.9%), and refractory status epilepticus (1.4%). EEG monitoring during the acute phase was normal in only 13% of patients. EEG findings in the acute phase included epileptiform abnormalities 19 (27.5%), electrographic seizures 19 (27.5%), electroclinical seizures in 6 patients (8.7%), and status epilepticus in six patients (8.7%). At discharge, 37.1% of patients were not on antiseizure medications, while 32.9% were on one, 24.3% on two, and 5.7% on three ASMs. Follow-up data for at least 12 months was available for all patients, with 92.7% remaining seizure-free. Follow-up EEGs showed epileptiform abnormalities in 11.8% of patients. The modified Rankin scale for children indicated that 50.7% had normal or insignificant abnormalities.


Conclusions: During the acute phase of PAHT, a high incidence of seizures was recorded (61.9%), which contrasts with the long-term follow-up, where 92.7% of patients remained seizure-free after 12 months. Furthermore, initial EEG was normal in only 13% of patients, yet follow-up EEGs demonstrated epileptiform abnormalities in only 11.8%. These results highlight the potential for substantial recovery in non-fatal PAHT cases from an epilepsy perspective. It is crucial to acknowledge that our research excluded cases of fatal PAHT, which might influence the interpretation of these favorable outcomes.

Funding: No funding was received in support of this abstract.