Electrographic Seizures and Antiseizure Medication Management in Pediatric Abusive Head Trauma: A Retrospective Cohort Study

Children with abusive head trauma (AHT) are at high risk for clinical and electrographic seizures, yet postdischarge epileptic outcomes remain incompletely characterized. We performed a single-center retrospective cohort study of 97 children with expert-confirmed AHT admitted between 2018 and 2023. Forty-three patients (44.3%) presented with concern for clinical seizures, and 33 (34.0%) had seizures during hospitalization. Among 62 patients monitored with continuous electroencephalography (EEG), 29 (46.8%) had electrographic seizures; 15 of these 29 (51.7%) were exclusively electrographic, and 26 (89.7%) had documented status epilepticus. Nine of 25 monitored patients without clinical seizures at presentation had electrographic seizures. Among 76 patients with postdischarge follow-up, 12 (15.8%) had seizure recurrence and 2 developed infantile spasms. Inpatient status epilepticus was associated with postdischarge seizure recurrence (odds ratio 10.29, 95% CI 2.20-67.09; P < .001). These findings support early continuous EEG use and structured longitudinal follow-up after AHT.