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Meta-Analysis
. 2022 Nov;63(11):2802-2812.
doi: 10.1111/epi.17398. Epub 2022 Sep 4.

Incidence and risk factors of posttraumatic epilepsy following pediatric traumatic brain injury: A systematic review and meta-analysis

Frederick P Mariajoseph  1 , Zhibin Chen  2 , Praba Sekhar  1 , Sarah S Rewell  2   3 , Terence J O'Brien  2   3   4 , Ana Antonic-Baker  2 , Bridgette D Semple  2   3   4
Affiliations
Meta-Analysis

Incidence and risk factors of posttraumatic epilepsy following pediatric traumatic brain injury: A systematic review and meta-analysis

Frederick P Mariajoseph et al. Epilepsia. 2022 Nov.

Abstract

Posttraumatic epilepsy (PTE) is a well-known chronic complication following traumatic brain injury (TBI). Despite some evidence that age at the time of injury may influence the likelihood of PTE, the incidence of PTE in pediatric populations remains unclear. We therefore conducted a systematic review to determine the overall reported incidence of PTE, and explore potential risk factors associated with PTE after pediatric TBI. A comprehensive literature search of the PubMed, Embase, and Web of Science databases was conducted, including randomized controlled trials and cohort studies assessing the incidence of PTE in TBI pediatric patients. We excluded studies with a sample size of <10 patients and those in which a pediatric cohort was not clearly discernable. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We found that the overall incidence of PTE following pediatric TBI was 10% (95% confidence interval [CI] = 5.9%-15%). Subgroup analysis of a small number of studies demonstrated that the occurrence of early seizures (cumulative incidence ratio [CIR] = 7.28, 95% CI = 1.09-48.4, p = .040), severe TBI (CIR = 1.81, 95% CI = 1.23-2.67, p < .001), and intracranial hemorrhage (CIR = 1.60, 95% CI = 1.06-2.40, p = .024) increased the risk of PTE in this population. Other factors, including male sex and neurosurgical intervention, were nonsignificantly associated with a higher incidence of PTE. In conclusion, PTE is a significant chronic complication following childhood TBI, similar to in the adult population. Further standardized investigation into clinical risk factors and management guidelines is warranted. PROSPERO ID# CRD42021245802.

Keywords: childhood; epilepsy; incidence; neurotrauma; pediatric; posttraumatic epilepsy; seizure; traumatic brain injury.

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Conflict of interest statement

None of the authors has any conflict of interest to disclose.

Figures

FIGURE 1
FIGURE 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) flowchart of article screening. PTE, posttraumatic epilepsy.
FIGURE 2
FIGURE 2
Pooled incidence of posttraumatic epilepsy (PTE) incidence, with 95% confidence interval (CI).
FIGURE 3
FIGURE 3
Correlation between early postinjury seizures and posttraumatic epilepsy (PTE). CI, confidence interval; IRR, incidence rate ratio.
FIGURE 4
FIGURE 4
Correlation between traumatic brain injury severity and posttraumatic epilepsy (PTE). CI, confidence interval; IRR, incidence rate ratio.
FIGURE 5
FIGURE 5
Correlation between intracranial hemorrhage and posttraumatic epilepsy (PTE). CI, confidence interval; IRR, incidence rate ratio.
FIGURE 6
FIGURE 6
Correlation between female sex and posttraumatic epilepsy (PTE). CI, confidence interval; IRR, incidence rate ratio.
FIGURE 7
FIGURE 7
Correlation between neurosurgical intervention and posttraumatic epilepsy (PTE). CI, confidence interval; IRR, incidence rate ratio.
FIGURE 8
FIGURE 8
Funnel plot analysis. The apparent asymmetry suggests a lack of publication bias. PTE, posttraumatic epilepsy.
See this image and copyright information in PMC

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