Post-traumatic epilepsy in children requiring inpatient rehabilitation following head injury. (Short Report).(Statistical Data Included)

Objective: To study the prevalence of, and identify possible risk factors for, the development of post-traumatic epilepsy in a cohort of children with severe head injury treated in an inpatient rehabilitation unit.

Methods: The hospital and community medical case notes of all children admitted prospectively to the unit and the records of the clinical EEG department over a seven year period were reviewed to identify those children who had developed late epilepsy after head injuries.

Results: 102 children received inpatient rehabilitation between 1 June 1991 and 28 February 1998. Follow up of these patients ranged from 18 months to over eight years. Nine patients (9%) developed post-traumatic epilepsy between eight months and over five years after the head injury. Three of the nine patients had experienced early tonic-clonic seizures in the first week after the injury. Other risk factors examined included the age of the patient, the cause of the head injury, initial Glasgow coma scale score, neuroimaging findings, and duration of ventilatory support. Only the presence of early seizures (p = 0.002) and possibly the Glasgow coma scale score (p = 0.043) were found to be specific risk factors for late late epilepsy.

Conclusions: Post-traumatic epilepsy appears to be uncommon, even in children with severe head injuries. Early seizures may indicate increased risk of developing late post-traumatic epilepsy in this study population.

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Epilepsy is a well recognised though uncommon complication of traumatic brain injury in children. The true prevalence is difficult to determine because of the wide range of severity of head injuries and the heterogeneity of the paediatric populations previously reported. Thus there are inconsistencies about which specific risk factors have been linked to the development of late post-traumatic epilepsy. Our aim in this prospective study was to identify the prevalence of late post-traumatic epilepsy in a relatively homogeneous population of children with severe head injuries who had required inpatient rehabilitation.

METHODS

All children treated by a paediatric rehabilitation programme between 1 June 1991 and 28 February 1998 were followed up prospectively for the development of post-traumatic epilepsy. Data collection ended on 31 August 2000, with the follow up period ranging from two and a half years to nine years.

At this children's hospital all children who require admission after a head injury are admitted to either the paediatric intensive care unit (PICU) or to a general surgical or orthopaedic ward, depending on their injuries. The specific management of children with traumatic brain injury on the PICU is dependent on the individual child. There were no significant changes in the general or specific management of children with traumatic brain injury during the study period. Criteria for referral of children with a head injury to the head injury rehabilitation team include all children admitted to the PICU irrespective of the severity of their injury or their neurological status, and all children admitted to a surgical or orthopaedic ward who, 24 hours after admission, showed any neurological symptoms or signs. All children referred to the rehabilitation team were assessed within 48 hours by one consultant paediatric neurologist (REA), who subsequently decided whether the child required inpatient rehabilitation or …