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Posttraumatic epilepsy in critically ill children with traumatic brain injury

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Abstract

Purpose

The aim of this study was to determine the clinical, laboratory, and radiological factors related with posttraumatic epilepsy (PTE).

Methods

The study is a multicenter descriptive cross-sectional cohort study. Children who followed up for TBI in the pediatric intensive care unit between 2014 and 2021 were included. Demographic data and clinical and radiological parameters were recorded from electronic case forms. All patients who were in the 6-month posttraumatic period were evaluated by a neurologist for PTE.

Results

Four hundred seventy-seven patients were included. The median age at the time of trauma was 66 (IQR 27–122) months, and 298 (62.5%) were male. Two hundred eighty (58.7%) patients had multiple traumas. The mortality rate was 11.7%. The mean duration of hospitalization, pediatric intensive care unit hospitalization and mechanical ventilation, Rotterdam score, PRISM III score, and GCS at admission were higher in patients with epilepsy (p < 0.05). The rate of epilepsy was higher in patients with severe TBI, cerebral edema on tomography and clinical findings of increased intracranial pressure, blood transfusion in the intensive care unit, multiple intracranial hemorrhages, and intubated patients (p < 0.05). In logistic regression analysis, the presence of intracranial hemorrhage in more than one compartment of the brain (OR 6.13, 95%CI 3.05–12.33) and the presence of seizures (OR 9.75, 95%CI 4.80–19.83) were independently significant in terms of the development of epilepsy (p < 0.001).

Conclusions

In this multicenter cross-sectional study, intracranial hemorrhages in more than one compartment and clinical seizures during intensive care unit admission were found to be independent risk factors for PTE development in pediatric intensive care unit patients with TBI.

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Abbreviations

EEG:

Electroencephalography

CT:

Computed tomography

GCS:

Glasgow Coma Score

ICP:

Intracranial pressure

ISS:

Injury Severity Score

PICU:

Pediatric intensive care unit

PRISM:

Pediatric risk of mortality

PTE:

Posttraumatic epilepsy

TBI:

Traumatic brain injury

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Acknowledgements

We would like to thank the staff of Ondokuz Mayıs University, Katip Celebi University, Çukurova University, and Ankara University, who participated in the study.

Author information

Authors and Affiliations

  1. Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey

    Nazan Ulgen Tekerek, Oguz Dursun & Alper Koker

  2. Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey

    Nazik Asilioglu Yener & Elif Kinik Kaya

  3. Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey

    Dincer Yildizdas & Faruk Ekinci

  4. Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Katip Celebi University, İzmir, Turkey

    Ayşe Berna Anıl & Fatih Durak

  5. Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey

    Tanil Kendirli, Edin Botan & Merve Havan

  6. Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey

    Selen Karalok, Ozgur Duman & Senay Haspolat

  7. Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey

    Ayşe Aksoy

  8. Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey

    Faruk Incecik

  9. Division of Pediatric Neurology, Department of Pediatrics, Katip Celebi Faculty of Medicine, İzmir, Turkey

    Nihal Olgac Dundar

  10. Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey

    Suleyman Sahin

  11. Akdeniz University Hospital, Dumlupınar Boulevard, Konyaalti, Antalya, 07059, Turkey

    Nazan Ulgen Tekerek

Authors
  1. Nazan Ulgen Tekerek
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  2. Oguz Dursun
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  6. Tanil Kendirli
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  11. Faruk Ekinci
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  14. Fatih Durak
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  15. Edin Botan
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  18. Ozgur Duman
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  19. Senay Haspolat
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Contributions

All authors contributed to the study conception and design. Dr. Nazan Ulgen Tekerek and Dr Dursun had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr Ulgen Tekerek, Dr Dursun, Dr Ekici, Dr Kinik, Dr Durak, and Dr Havan contributed to acquisition, analysis, or interpretation of data. Dr. Ulgen Tekerek contributed to statistical analysis. Dr. Ulgen Tekerek and Dr Dursun contributed to drafting of the article. All authors contributed to critical revision of the article for important intellectual content and approved the final manuscript.

Corresponding author

Correspondence to Nazan Ulgen Tekerek.

Ethics declarations

Ethics approval

Data collection and retrospective analysis were conducted under the approval of Akdeniz University Clinical Research Ethics Review Board (Date: 07.07.2021 No: KAEK-528). Procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

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Ulgen Tekerek, N., Dursun, O., Asilioglu Yener, N. et al. Posttraumatic epilepsy in critically ill children with traumatic brain injury. Childs Nerv Syst 39, 3207–3214 (2023). https://doi.org/10.1007/s00381-023-06087-9

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  • DOI: https://doi.org/10.1007/s00381-023-06087-9

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