Li Vivien W Y, Wang Yuliang, Tso Winnie W Y
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital and Duchess of Kent Children's Hospital, Hong Kong SAR, China.
Department of Psychology, The University of Hong Kong, Hong Kong SAR, China.
Front Neurol. 2025 Sep 10;16:1629669. doi: 10.3389/fneur.2025.1629669. eCollection 2025.
The purpose of this study is to determine the prevalence, risk factors, and characteristics of seizures and epilepsy in children with acquired brain injury (ABI), and compare their outcomes with children with ABI but no seizures.
Basic demographic data, clinical features, brain injury severity, seizure and epilepsy characteristics, and functional and neurodevelopmental outcomes of children with ABI with follow-up of at least 2 years were reviewed. Logistic regression was performed to determine the risk factors for seizures.
The study included 82 children with ABI due to tumors, trauma, hypoxia, stroke, infection, and neuro-inflammatory disorders. There were 43 (52%) boys. The median age at diagnosis was 2.9 years and median follow-up interval was 5 years. A total of 27 (33%) children experienced seizures and 20 (24%) were diagnosed as having epilepsy. Risk factors for seizures included cortical brain injury ( = 0.013) and central nervous system (CNS) infection ( = 0.001). Among those with seizures, seven had acute seizures within 7 days of ABI. The median time of onset of epilepsy after ABI was 2 years, and five children had refractory epilepsy (RE) needing more than two anti-epileptics. The hazard ratio (HR) for epilepsy in those with cortical brain injuries and CNS infections were 4.582 (95% CI [1.83, 11.49], = 0.001) and 4.796 (95% CI [1.568, 14.67], = 0.006), respectively. HR for epilepsy onset in those who had post-stroke seizures were 4.467, 95% CI [1.575, 12.67], =0.005). Most subjects demonstrated significant improvements in Karnofsky Performance Scale (KPS) scores following rehabilitation ( < 0.0001); however, a greater proportion of children with post-ABI seizures required special educational services ( = 0.025).
Cortical brain injuries, CNS infection and post-stroke seizures significantly increase the risk of epilepsy in children with ABI. While functional improvements were observed after rehabilitation, children with post-ABI seizures more often required special educational support. The identification of risk factors for seizures, time to epilepsy onset, and the functional outcomes can guide subsequent management and counseling.
本研究旨在确定获得性脑损伤（ABI）患儿癫痫发作和癫痫的患病率、危险因素及特征，并将其预后与无癫痫发作的ABI患儿进行比较。
回顾了至少随访2年的ABI患儿的基本人口统计学数据、临床特征、脑损伤严重程度、癫痫发作和癫痫特征以及功能和神经发育结局。进行逻辑回归分析以确定癫痫发作的危险因素。
该研究纳入了82例因肿瘤、创伤、缺氧、中风、感染和神经炎症性疾病导致ABI的患儿。其中43例（52%）为男孩。诊断时的中位年龄为2.9岁，中位随访时间为5年。共有27例（33%）患儿发生癫痫发作，20例（24%）被诊断为癫痫。癫痫发作的危险因素包括皮质脑损伤（P = 0.013）和中枢神经系统（CNS）感染（P = 0.001）。在癫痫发作患儿中，7例在ABI后7天内发生急性癫痫发作。ABI后癫痫发作的中位发病时间为2年，5例患儿患有难治性癫痫（RE），需要两种以上抗癫痫药物治疗。皮质脑损伤和CNS感染患儿癫痫的风险比（HR）分别为4.582（95%CI[1.83, 11.49]，P = 0.001）和4.796（95%CI[1.568, 14.67]，P = 0.006）。中风后癫痫发作患儿癫痫发作的HR为4.467，95%CI[1.575, 12.67]，P = 0.005）。大多数受试者在康复后卡氏功能状态量表（KPS）评分有显著改善（P < 0.0001）；然而，ABI后癫痫发作的患儿中需要特殊教育服务的比例更高（P = 0.025）。
皮质脑损伤、CNS感染和中风后癫痫发作显著增加了ABI患儿癫痫的风险。虽然康复后观察到功能改善，但ABI后癫痫发作的患儿更常需要特殊教育支持。确定癫痫发作的危险因素、癫痫发作时间和功能结局可指导后续的管理和咨询。
