034 - Latency of Seizures in Abusive Head Trauma

Publication Number: 34.5700

Barrie J. Kaiser, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Erica Prendergast, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Andrea C.. Pardo, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Audrey Raut, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; MARY Clyde Pierce, Ann & Robert H. Lurie Children's Hospital of Chicago, EVANSTON, IL, United States

Background: Abusive Head Trauma (AHT) is a leading cause of morbidity and mortality in children. It is defined by the CDC as injury to the skull or intracranial contents of a young child due to inflicted blunt impact and/or shaking. Patients with AHT are at increased risk for developing seizures compared to patients with accidental head trauma. Patients < 1 year of age are more likely than children >1 year of age to exhibit subclinical or electrographic (EEG)-only seizures. At present, there is no evidence-based consensus on duration of EEG monitoring in this setting.

Objective: We sought to characterize the latency of EEG seizure onset for patients with AHT and describe new imaging findings in the setting of seizures.

Design/Methods: This retrospective single-center observational study from 2017-2022 evaluated patients less than 2 years of age with AHT evaluated by the Child Abuse Pediatrics (CAP) Team and Neurocritical Care (NCC) team. The primary outcome was time to seizure onset on EEG following admission. Secondary outcomes included number of antiseizure medications (ASM) needed and neuroimaging findings.

Results: Forty-three children were evaluated by our CAP and NCC teams with a diagnosis of AHT. Thirty-six children were evaluated with prolonged video EEG monitoring (male 80.5%, n=29). Seventeen of thirty-six patients (47%) had seizures on EEG, and eleven of thirty-six (30.5 %) had seizure onset on EEG >24 hours after connection. Sixteen children < 1 year of age had seizures on EEG, and ten of those sixteen (62%) had seizure onset after 24 hours of EEG monitoring. The median time to seizure onset on EEG was 34.6 hours (IQR 8.4-72.1h). Only one patient >1 year of age had seizure onset >24 hours after EEG initiation. Fifty three percent of children with seizures had non convulsive status epilepticus (n= 9). Children with EEG seizures required a median of 2 ASMs for treatment (IQR 1-3). Of note, five of the eleven children with longer latency of seizures on EEG were also found to have new Diffusion Weighted Imaging (DWI) changes on imaging that were not present on their initial brain MRI.

Conclusion(s): Children less than 1 year of age with AHT have seizures that may present after 24 hours following initiation of EEG. Children with AHT younger than 1 year of age may benefit from longer EEG monitoring than typically needed for children with other causes of acute symptomatic seizures. Of those patients with delayed seizure onset, a portion will have delayed DWI changes on repeat MRI of unclear etiology. Further study is needed to characterize these findings.