The ideal treatment of children with
head trauma would include prevention of posttraumatic
seizures. Ninety-two of 937 children with
head injuries (9.8%) experienced posttraumatic
seizures. In 94.5% of these patients (87 of 92),
seizures developed within the first 24 hours after injury. Three children convulsed between 24 hours and 7 days, but only 2 children developed
seizures after the 1st week. Factors found to influence the likelihood of
seizures included severe
head injury (GCS, 3 to 8), diffuse
cerebral edema, and
acute subdural hematoma (P less than 0.001).
Seizures occurred in 35% of severely head-injured children compared to 5.1% with
minor head injury (P less than 0.001). A less significant correlation (P less than 0.1) was noted between
seizures and open,
depressed skull fractures. We found no significant correlation between seizure occurrence and numerous other factors including age, sex, fracture location and type (other than open, depressed fractures), parenchymal
injuries, fixed neurological deficits, and cranial operation. Based on our observations, we recommend the prophylactic use of
anticonvulsants in children at higher risk for posttraumatic
seizures: those with diffuse
cerebral edema,
acute subdural hematoma, open,
depressed skull fracture with parenchymal damage, or severe
head injury (GCS less than or equal to 8).