Electroencephalogram pattern predicting neurological outcomes of children with seizures secondary to abusive head trauma

• Published in: Pediatrics and neonatology Vol. 65; no. 3; pp. 249 - 254
• Main Authors: Chou, Cheng-Che, Hou, Ju-Yin, Chou, I-Jun, Lan, Shih-Yun, Kong, Shu-Sing, Huang, Man-Hsu, Weng, Yu-Chieh, Lin, Yi-Yu, Kuo, Cheng-Yen, Hsieh, Meng-Ying, Chou, Min-Liang, Hung, Po-Cheng, Wang, Huei-Shyong, Lin, Kuang-Lin, Wang, Yi-Shan, Lin, Jainn-Jim
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.05.2024; Elsevier
• Subjects: Abusive head trauma; Brain injury; Child; Child Abuse; Child, Preschool; Craniocerebral Trauma - complications; Craniocerebral Trauma - physiopathology; Electroencephalography; Female; Humans; Infant; Male; Outcome; Prognosis; Retrospective Studies; Seizure; Seizures - etiology; Abusive head trauma; Child abuse; Electroencephalography; Seizure; Outcome; Brain injury
• ISSN: 1875-9572; 2212-1692
• DOI: 10.1016/j.pedneo.2023.05.012

The clinical presentations of abusive head trauma can abruptly worsen, so the occurrence of seizures and changes of EEG can be variable according to patients’ conditions. Since the changes of EEG background waves reflect the cortical function of children, we aimed to find out whether the timing of EEG background, epileptiform discharges and seizure patterns were associated with the outcomes of patients with AHT. Using seizure type and acute stage electroencephalographic (EEG) characteristics to assess adverse neurological outcomes in children with seizures secondary to abusive head trauma (AHT). Children who were hospitalized with AHT at a tertiary referral hospital from October 2000 to April 2010 were evaluated retrospectively. A total of 50 children below 6 years of age admitted due to AHT were included. KOSCHI outcome scale was used to evaluate the primary outcome and neurological impairment was used as secondary outcome after 6 months discharge. Children with apnea, cardiac arrest, reverse blood flow and skull fracture in clinic had a higher mortality rate even in the no-seizure group (3/5 [60%] vs. 3/45 [6.7%], odds ratio [OR] = 11; 95% CI = 2.3–52; p = 0.025). Seizure occurrence reduced mostly at the second day after admission in seizure groups; but children with persistent seizures for 1 week showed poor neurological outcomes. The occurrence of initial seizure was frequency associated with younger age; focal seizure, diffuse cortical dysfunction in acute-stage EEG, and low Glasgow Coma Scale (GCS) score were significantly related to poor outcomes after 6 months. Diffuse cortical dysfunction was also associated with motor, speech, and cognitive dysfunction. Diffuse cortical dysfunction in acute-stage EEG combined with low GCS score and focal seizure may related to poor outcomes and neurological dysfunctions in children with AHT. •Ages of the children in the repetitive seizures and status epilepticus groups were younger than in the single seizure group in abusive head trauma.•No significant differences in outcome between the seizure groups.•EEG findings of diffuse cortical dysfunction, focal seizures and severe Glasgow Coma Scale were significantly related to poor outcomes.•Acute-stage background EEG of diffuse cortical dysfunction could predict poor outcomes with the development of multiple neurological dysfunctions.