[PS7-1C-1] Outcomes in pediatric traumatic brain injury (TBI)- special focus on epilepsy
Outcomes after pediatric TBI vary widely. Outcome studies generally have demonstrated that risk factors for severe outcomes include the severity of injury – mild , moderate & severe as well the age of TBI and the etiology. For instance severe deficits were seen with inflicted TBI (Abusive TBI), the commonest etiology in infants and young children in the US. In countries like India, where falls are the most common etiology in < 5 yrs of age and motor vehicle accidents in older children & teenagers, a good outcome was seen even in moderate TBI. Though earlier motor, obvious cognitive & visual outcomes were emphasized, recent studies have focused on subtle neuropsychiatric outcomes and behavior abnormalities which appear to be very common. Severe head injuries with admission GCS of 3-4 have uniformly bad outcomes of death or severe disability. Early decompressive craniectomy appears to benefit such children, in contradistinction to adults.
Seizures have traditionally been divided into impact seizures, early post-traumatic seizures (E-PTS) and late post-traumatic epilepsy (PTE). The incidence of PTS is much higher in institutional studies as compared to community studies – as many as 23% in one Indian study. Again inflicted TBI has a high incidence of EPTS – often SE. Continuous EEG studies in moderate-severe TBI show very high rates of subclinical seizures. EPTS occur usually in the first 12 hours post injury and prophylactic anti-epileptic drugs (AEDs) seem to decrease the incidence, though the choice of AED remains debatable.
Late PTE occurred in ~11% in a Swedish study while it was lower in an Indian study suggesting again that there are many variables involved. EPTS are a significant Also most agree that routine use of AEDs to prevent epilepsy is not warranted and AEDs if given should be for a few weeks at the most. In severe head injuries, especially inflicted TBI, drug-resistant epilepsy remains a problem.
Seizures have traditionally been divided into impact seizures, early post-traumatic seizures (E-PTS) and late post-traumatic epilepsy (PTE). The incidence of PTS is much higher in institutional studies as compared to community studies – as many as 23% in one Indian study. Again inflicted TBI has a high incidence of EPTS – often SE. Continuous EEG studies in moderate-severe TBI show very high rates of subclinical seizures. EPTS occur usually in the first 12 hours post injury and prophylactic anti-epileptic drugs (AEDs) seem to decrease the incidence, though the choice of AED remains debatable.
Late PTE occurred in ~11% in a Swedish study while it was lower in an Indian study suggesting again that there are many variables involved. EPTS are a significant Also most agree that routine use of AEDs to prevent epilepsy is not warranted and AEDs if given should be for a few weeks at the most. In severe head injuries, especially inflicted TBI, drug-resistant epilepsy remains a problem.