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Late post traumatic epilepsy

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Estimates of the incidence of late epilepsy after head injury in children have varied considerably, probably because of differences in the populations studied. Rates of below 5% and above 20% have been reported. In Liverpool (

) the reported incidences were 0.9% in 1000 children admitted to hospital with head injuries, 3.4% in the 262 referred to the head injury rehabilitation team, and 9% in the 102 children who needed rehabilitation. The children referred to the rehabilitation team were followed up for periods varying from 19 months to 7 years.

Late post traumatic epilepsy occurred in 9 of the 102 children who received inpatient rehabilitation but in none of the others. Of the 102 children 90 had been admitted to the paediatric intensive care unit and 87 had needed mechanical ventilation. The nine children who developed late post traumatic epilepsy were aged 1.3–13.6 years at the time of head injury and the latent period between head injury and onset of late post traumatic epilepsy varied between 0.7 and 5.1 years. All had complex partial seizures or secondarily generalised tonic-clonic seizures or both and two also had simple partial sensory seizures. Four had hemiplegia and one tetraplegia. Five had learning difficulties and three behaviour difficulties. Only one child was neurologically normal and had neither learning nor behaviour problems. Seven had an abnormal EEG after the onset of late post traumatic epilepsy. MRI showed focal changes in four children, multifocal changes in three and was normal in two.

Ten of the 102 children had tonic-clonic seizures in the first week after injury, two of them immediately (within minutes) after injury. Three of the 10 (but neither of the two with immediate seizures) developed late post traumatic epilepsy. Fifteen children had either episodes of stiffening or paroxysmal autonomic changes in the first week but none of these developed late post traumatic epilepsy during the period of follow up. Two factors were significantly associated with the development of late posttraumatic epilepsy; they were early tonic-clonic seizures and low Glasgow coma scale score (<8) when first seen.

Late post traumatic epilepsy is not common even after severe head injury. First week tonic-clonic seizures and low initial Glasgow coma scale score increase the risk.