Abstracts

Rationale: Abusive head trauma (AHT) causes death and disability in children. Post-traumatic seizures (PTS) are common in AHT and cause secondary neurological injury. Previous studies have estimated the incidence of clinical PTS between 33 and 73%, with the incidence of non-convulsive seizures (NCS) as high as 57%. The study of the characteristics and true burden of PTS is important to develop effective strategies to improve neurological outcomes. Our objectives were to study the incidence and risk factors for PTS, utilization of continuous EEG (cEEG), management with anti-epileptic drugs (AEDs) and clinical outcomes in victims of AHT.

Methods: We assembled a cohort of children aged < 36 months, who suffered AHT and were subsequently admitted to an academic children’s hospital, between January 2011 and May 2021. Data pertinent to demographics, clinical features, management and follow-up were collected by retrospective chart review. The data was categorized into two groups, those who did and did not develop PTS during hospitalization. The Chi-square and two-sample t-test were used to compare risk factors and means of the two cohorts, respectively.

Results: Over 11 years, 92 cases of AHT were identified. Among them, 60 AHT victims developed PTS during hospitalization (65.2%). Mean age was 6 ±5.8 months and predominantly consisted of males (65%). The profile of patients with and without PTS are compared in Table 1. Factors associated with higher likelihood of seizures were subdural hematoma (SDH) (OR 5.32 [95% CI 1.27-22.2]) and co-morbidities like prematurity (OR 5.45 [95% CI 1.16-25.48]). The association of parenchymal injury with PTS was not statistically significant (0.79 [95% CI 0.33-1.91]). SDH was the most common extra-axial injury (98%) in the PTS group and 25% needed surgical evacuation. Compared to patients without seizures, PTS patients had longer intensive care unit (ICU) and hospital stays by 4.1 ±3.0 and 7.8 ±6.6 days, respectively (p< 0.05). The clinical profile of PTS is summarized in Table 2. Over 90% of PTS, occurred within the first week of hospitalization. Mean time to cEEG initiation was 14.7 hours. Incidence of NCS was 48.3% (n=29). Nearly 50% of seizures continued into non-convulsive status epilepticus (NCSE). Of those, only 3 cases had purely electrographic seizures. Although levetiracetam (LVA) was the most commonly used AED, monotherapy with the same was ineffective in >50%. Although a majority (80%) of the children were discharged on AEDs, a good number (35%) were weaned off at follow-up. The mortality rate in the PTS group was < 5%. The most common long-term sequelae in both cohorts were developmental delay and epilepsy, with some developing intractable epilepsy months after original insult.